| Staff Nurse - RN, Sr. - Medical Management Job Description |
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| The following is a full job description for Staff Nurse - RN, Sr. - Medical Management. Here are the requirements and responsibilities for Staff Nurse - RN, Sr. - Medical Management along with statistics. If after reading this page you determine that Staff Nurse - RN, Sr. - Medical Management is not the position you are looking for, you may want to try one of these similar titles: Staff Nurse - RN, Sr. - Medical Management, Staff Nurse - RN II, Staff Nurse - RN III, Staff Nurse - RN - Occupational Health, Staff Nurse Senior- RN - Occupational Health, Staff Nurse - RN - Medical Management, Staff Nurse - RN - Dialysis, Staff Nurse - RN - Flight Transport, Staff Nurse - RN I, Staff Nurse - RN - CCU |
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| Requirements and Responsibilities For Staff Nurse - RN, Sr. - Medical Management |
| Leads the coordination between care providers and plan members with the goal of maximizing member benefits while managing costs. Oversees the assessment of medical necessity of procedures and/or admissions, conducts pre-certification or authorization, and ensures compliance with established guidelines. Assists members in appeals for denied services. Interprets benefits and guides members to choose to the appropriate providers, projects and resources. Applies the medical and reimbursement policies within the claim adjudication process. Typically requires a bachelor's degree in Nursing. Typically reports to a manager. Requires RN license. Typically requires more than 5 years of related experience. Contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. |
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| Also referred to as: Patient Benefit and Care Nurse Coordinator II, Patient Care Authorization Senior Nurse, Senior Nurse Manager, Care Coordination, Senior Nurse Manager, Member Benefit Coordination |
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| Similar Jobs: Staff Nurse - RN, Sr. - Medical Management, Staff Nurse - RN II, Staff Nurse - RN III, Staff Nurse - RN - Occupational Health, Staff Nurse Senior- RN - Occupational Health, Staff Nurse - RN - Medical Management, Staff Nurse - RN - Dialysis, Staff Nurse - RN - Flight Transport, Staff Nurse - RN I, Staff Nurse - RN - CCU |
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| Level of Education: Staff Nurse - RN, Sr. - Medical Management Salaries with No Diploma, Staff Nurse - RN, Sr. - Medical Management Salaries with a High School Diploma or Technical Certificate, Staff Nurse - RN, Sr. - Medical Management Salaries with an Associate's Degree, Staff Nurse - RN, Sr. - Medical Management Salaries with a Bachelor's Degree, Staff Nurse - RN, Sr. - Medical Management Salaries with a Master's Degree or MBA, Staff Nurse - RN, Sr. - Medical Management Salaries with a JD, MD, PhD or Equivalent |
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| Industries: Business Services, Edu., Gov't. & Nonprofit, Healthcare, Insurance | |
