Clinical Review Registered Nurse

Subject Matter Expertise Strong knowledge base in health care delivery systems, health insurance, medical care practices and trends, regulatory and accreditation agencies/standards, and provider network management. Strong knowledge of all Plan products and services benefits that effect clinical decision making. Strong knowledge of clinical nursing practice. Computer Skills – Proficient in all Microsoft Office applications; proficient in CPT, HCPCS coding and ICD- 10 diagnosis codes. Proficient in specialized computer applications preferred including SalesForce Health Cloud, Acuity, Microsoft CRM, Onbase(or similar document mgt system), Jira Analytical Skills – Strong analytical skills, including statistical data analysis. Communication Skills – Strong written and oral communication skills Interpersonal Skills – Strong interpersonal skills Organizational Abilities – Strong organizational skills 5 – 7 years of clinical practice required 1- 3 years of insurance related experience desired. Willing to participate in required on-going CEU training. Licensed RN ; BSN desired; Licensed in compact state desired

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