Clinical Stop Loss Nurse - Work From Home

Health Care Service Corporation•Helena, MT

5d•$84,400 - $152,300•Remote

About The Position

This position is responsible for the review of case management notes, large claims reports and shock reporting for individuals and groups seeking stop loss insurance quotes and renewals. The position works closely with internal claim, clinical and case management teams to develop ongoing care and cost projections. The projections are then communicated to underwriting to help evaluate potential risk and associated costs.

Requirements

Bachelor's degree in nursing is preferred with current state licensure and at least 3-5 years of clinical experience
2-4 years experience with Stop Loss products and clinical programs
Strong analytical and problem solving skills
Excellent organizational and time management skills, able to work independently with little supervision while handling numerous projects at once
Excellent written/verbal communication skills, especially the ability to communicate effectively with underwriting staff
Must have a track record of producing work that is highly accurate, demonstrates attention to detail, and reflects well on the organization
Computer proficiency, specifically strong typing skills and Internet research skills, must have a clear understanding of Microsoft Word, Microsoft Office and Excel.

Nice To Haves

Clinical claims review and claims auditing experience
Experience in managing complex or catastrophic health cases
Specialty clinical experience in intensive care medicine, orthopedic, NICU/pediatric, oncology, diabetic member management, obstetric (low to high risk maternity management)
Working toward or completion of CCM/CCP/CDE/MCG certification or Advanced degree
Knowledge of Milliman Guidelines or similar clinical guidelines
Knowledge of medical management policies and procedures

Responsibilities

Review of case management notes, large claims reports and shock reporting for individuals and groups seeking stop loss insurance quotes and renewals.
Work closely with internal claim, clinical and case management teams to develop ongoing care and cost projections.
Communicate projections to underwriting to help evaluate potential risk and associated costs.
Complete cost projections on new and renewal business within 24-48 hours of receipt.
Documentation with clinical summary and estimated cost of care for each individual identified as at risk.