Clinical Review Nurse Team Lead RN, BSN

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.

About the role

Roundstone is committed to driving value for our clients in our medical Stop Loss captive insurance program. We have a dedicated team to provide clinical expertise as part of our cost containment strategy. The Clinical Review Team Lead ensures timely, high-quality clinical reviews, manages work allocation across the team, and serves as a key operational partner to Customer Success, Underwriting, and Claims. The Team Lead is accountable for the daily workflow, prioritization, and on-time completion of medical reviews performed by clinical review nurses. The role also follows up with Advisors and TPAs to obtain missing claims documentation, clinical records, or supplemental reporting needed to complete reviews.

In addition, the Team Lead acts as a liaison and escalation point for high-dollar claims issues, working closely with the Claims team to resolve complex cases, align on next steps, and support accurate and timely review outcomes. The Team Lead also drives process improvements and leads training to ensure consistency and quality among the nursing team. This role is ideal for a clinically experienced leader who thrives in a fast-paced, highly accountable environment and can balance team leadership, operational rigor, and cross-functional collaboration to support accurate and timely medical stop loss reviews.

Responsibilities

• Ensure timely, high-quality clinical reviews
• Manage work allocation and prioritization across the clinical review team
• Serve as a key operational partner to Customer Success, Underwriting, and Claims teams
• Oversee daily workflow and on-time completion of medical reviews
• Follow up with Advisors and TPAs to obtain missing claims documentation, clinical records, or supplemental reporting
• Act as a liaison and escalation point for high-dollar claims issues
• Collaborate with the Claims team to resolve complex cases and align on next steps
• Drive process improvements and lead training to ensure consistency and quality among the nursing team

Requirements

• Bachelor’s degree in nursing (BSN, RN)
• Experience leading teams in a clinical or business environment (Insurance industry experience a plus, e.g., medical stop loss, health plan operations, claims review, or related healthcare environment)
• Medical coding or medical billing experience and/or clinical review or utilization review experience

Skills

• Strong work ethic and comfortable working with immediacy
• Proven ability to manage workflow, coordinate team priorities, and deliver against deadlines
• Strong cross-functional collaboration and communication skills
• Business acumen and problem-solving skills with a customer focus to resolve escalations
• Active listening and ability to support the clinical team while coordinating priorities
• Ability to drive process improvements, especially related to workflow, tools, and tracking

Benefits

• Medical, dental, and vision benefits
• Annual bonus
• Dependent care 100% match up to max allowable
• Parental leave
• PTO beginning on Day 1
• Tuition reimbursement
• 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

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. To achieve a better match from both the candidate's perspective and our organization, please take this brief survey: https://go.cultureindex.com/p/60lfPKPYh4HO