Staff Nurse - RN - Medical Management coordinates with care providers and plan members with the goal of maximizing member benefits while managing costs. Assesses medical necessity of procedures and/or admissions, conducts pre-certification or authorization, and monitors compliance with established guidelines. Being a Staff Nurse - RN - Medical Management assists members in appeals for denied services. Interprets benefits and guides members to choose to the appropriate providers, projects and resources. Additionally, Staff Nurse - RN - Medical Management typically requires a bachelor's degree in nursing. Typically reports to a manager. Requires a valid state RN license. To be a Staff Nurse - RN - Medical Management typically requires 3-5 years of related experience. Gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. (Copyright 2024 Salary.com)
The Registered Nurse will provide guidance, oversight and services to the health services department to ensure the quality care of all residents and regulatory compliance of the assigned community. This position requires creativity and flexibility with residents who have complex situations and is at times stressful. The Registered Nurse will be responsible for providing the outlined services, following the nurse practice act, and ensuring quality care to all residents in their care.
As Needed (PRN) employees typically work less than 86.67 hours per month or less than 25 hours per week. Based on the variable need of the position there may be instances where as many as 40 hours are needed per week. Assignments requiring 30-40 hours per week for greater than 4 weeks may require change to the company payroll in an interim position and will be agreed upon in advance.
Please note:
Except as otherwise required by applicable law, employees in this category are not entitled to company benefits other than worked-holiday and sick benefits. This position will be expected to accept at least 1 out of every 3 assignments offered to maintain PRN status. Exact travel availability, states of availability and length of assignments will be reviewed and agreed upon in writing upon hire. After hire, any updates to availability should be provided in writing with a minimum two weeks’ notice.
Duties and Responsibilities:
Routine Duties that may be asked of “As Needed” Registered Nurse:
Universal Requirements:
Physical Requirements:
Other Requirements: