Clinical Benefits Support RN Specialist
Job Summary
A company is looking for a Clinical Benefits Support RN Specialist to evaluate medical eligibility for benefits enrollment and support community-based services for individuals with serious mental illness.
Key Responsibilities:
- Evaluate medical/pharmacy claims data and medical records for benefits eligibility
- Guide community teams on level of application support for individuals
- Create clinical summaries to support benefits program applications
Required Qualifications:
- Evaluating claims and clinical documentation for benefits enrollment
- Strong knowledge in medical care and treatment-related therapies
- Experience in care plan creation and clinical documentation quality review
- Ability to translate complex clinical requirements into actionable next steps for community teams
- Familiarity with evidence required to support benefits applications
COMPLETE JOB DESCRIPTION
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