Medical Review Nurse- Stop Loss

Medical Review RN – Stop Loss

Founded in 2003, Roundstone is not your typical insurance company. We’re on a mission to help employers save on healthcare benefits so they can put those savings towards bettering their businesses and taking care of their employees.

Role Description

As a Medical Review Nurse in Roundstone’s medical expense stop loss program, you will work with the claims staff to identify potentially large claims early in the process and use your expertise to manage the medical services. You’ll serve as a subject matter expert on newly approved and emerging treatments and help spot trends in patient care. Third party administrators and vendors will work closely with you on a regular basis. This position also works closely with the stop loss underwriters when preparing renewal and potential quotes for cost predictions and cost containment options. Review of amendments and informing underwriters if this addition to the plan will have a significant financial impact on the group. This is a great opportunity for someone with a nursing background to move into the insurance field.

Key Duties & Responsibilities:

• Ability to recognize potentially catastrophic diagnoses.
• Strong communicator, particularly regarding discussing and concisely summarizing medical conditions with non-medical professionals.
• Recognizes salient data to leverage in individual cases and trend for business stakeholders.
• Capable of identifying and completing tasks with minimal direct instruction. Tracks results and communicates status with stakeholders.
• Ability to multitask, prioritize, and find creative problem resolutions.
• Open collaborator with the ability to influence and lead indirectly.
  
  
  

Skills and Qualifications:

• Bachelor's degree in nursing
• Oncology and Critical Care experience a plus
• Exposure to medical billing, coding, and negotiation is a plus, but not required
• Minimum of 2 years nursing experience
• Experience reviewing/auditing medical records related to patient treatment, diagnosis, and provider billing to identify any medical and coding discrepancies.
• Critical/analytical skills with a strong attention to detail
• Strong work ethic
  
  
  

Better Benefits:

We’re leaders in our industry, so naturally, we look out for our employees’ best interests with a robust benefits package. Roundstone employees are eligible for:

• Medical, dental and vision benefits
• Annual bonus
• Dependent care 100% match up to max allowable
• Parental leave
• Parental leave
• PTO beginning on Day 1
• Tuition reimbursement
• Healthy work/life balance
• Hybrid office schedule
• 401(k) plan with company match
• Employee Assistance Program
• On-site gym with personal trainer access
• Life insurance and short term disability insurance
  
  
  

More About Roundstone

Headquartered in Rocky River, Ohio, Roundstone is proud to be a Northeast Ohio Top Workplace as recognized by The Plain Dealer and cleveland.com , based on anonymous employee feedback. We foster a supportive, values-driven culture where employees feel engaged, valued, and celebrated. Roundstone has also been named an Inc. 5000 award recipient for eight consecutive years, reflecting our continued growth and success.

Our Core Values

• Live well: Be healthier and bring positive energy to all you do.
• Work smarter: Get things done, better.
• Own it: Accountability is your middle name. Be on time, do what you say, and finish what you start.
• Be intellectually curious: Always be learning. See opportunity everywhere and have a drive to know.
  
  
  

Culture and fit are integral to success and in an effort to achieve a better match both from a candidate's perspective and our organization, please take a minute, click on the link and take the really brief survey:

https://go.cultureindex.com/p/vdNOUHg4OcQTU

Don't meet every single requirement? Studies have shown that women and people of color are less likely to apply to jobs unless they meet every single qualification. At Roundstone Insurance we are dedicated to building a diverse, inclusive, and authentic workplace, so if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyways. You may be just the right candidate for this or other roles.