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)
PURPOSE AND SCOPE:
The registered professional nurse RN CAP 1 is an entry level designation into the Clinical Advancement Program (CAP). This position is accountable and responsible for the provision and coordination of clinically competent care including assessment planning intervention and evaluation for an assigned group of patients. Assesses and manages patients’ response to dialysis training and treatment therapy by following prescribed predetermined protocols and communicates patient related issues to the physician as needed. As a member of the End Stage Kidney Disease (ESKD) health care team this position participates in decision-making teaching leadership functions and quality improvement activities that enhance patient care outcomes and facility operations.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
All duties and responsibilities are expected to be performed in accordance with Fresenius Kidney Care policy procedures standards of nursing practice state and federal regulations.
PHYSICAL DEMANDS AND WORKING CONDITIONS:
The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
SUPERVISION:
Assigned oversight of LPNs/LVNs RNs Patient Care Technicians and Home Therapy Care Team Assistants as a Team Leader or designated Nurse in charge after meeting all the following:
EDUCATION and LICENSURE:
EXPERIENCE AND REQUIRED SKILLS:
EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity
Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.
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0 Staff Nurse - RN, Sr. - Medical Management jobs found in Reno, NV area