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. Being a Staff Nurse - RN, Sr. - 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, Sr. - Medical Management 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. To be a Staff Nurse - RN, Sr. - Medical Management 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. (Copyright 2024 Salary.com)
Welcome to RNstaff, where compassion connects careers. We're not just a recruiting company; we're people who care about people. Join us in shaping the future of healthcare together.
RNStaff is looking for USRNs looking for a permanent contract in the State of Alaska. International RNs looking for sponsorship program are very welcome.
See Job Description:
Location: Alaska
Position: RN Stepdown
Responsibilities:
Certifications - Required
AHA BLS - Basic Life Support Certificate
Education - Required
Graduate of accredited Nursing program
Experience - Required
1 - 2 year Acute Care Experience and/or experience congruent with role in service line
Licenses - Required
Registered Nurse State of Alaska
Ann Dizon
Account Manager
317 328 2866
ann@rnstaff.com