Pennsylvania Licensed Medical Review Nurse

Job Summary

To support Novacore's Claim and Underwriting Departments, the part-time Pennsylvania Licensed Medical Review Nurse will evaluate clinical and claim data, assist with catastrophic claim management, and maintain patient confidentiality while working remotely or in a hybrid schedule from the Conshohocken, PA Home Office or Minneapolis, MN Carbon Office.

Key responsibilities:

• Assist underwriters in evaluating clinical and claim data to identify potential risks
• Provide medical resources for catastrophic claim management in collaboration with Third-Party Administrators and producers
• Conduct clinical reviews and claims analysis to assess trends and recommend reserve actions

Required qualifications:

• Registered Nurse licensure with a bachelor's degree in nursing or science preferred
• At least one year of acute care clinical experience required
• Experience in Utilization Management (UM) or Case Management (CM) on either the payer or provider side
• Prior experience analyzing healthcare claims and coding, particularly with catastrophic claims
• CCM certification preferred