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)
Blake Senior Living
COMMUNITY NAME is a resort-style senior living community off Street Name Goes here in CITY, STATE. We are part of QSL Management which is a fast-growing senior living company with ample opportunities for advancement. Our mission is to provide seniors luxurious and comfortable home with resort-style hospitality promoting wellness, security, longevity, family, joy, and self-worth. We believe in fostering an environment in which our team members can grow and thrive, and we look for leaders who exemplify our core values of Excellence, Compassion, Respect, Leadership, Integrity, Safety & Joy.
We have an immediate need for a Staff Nurse (RN or LPN) at (name of community) in (name of city & state).
We offer competitive wages and an excellent benefits package. Plus, we have a great work environment where you can make a difference in the lives of older adults. If this sounds like the opportunity that you've been looking for, apply for this position today!
Primary Responsibilities:
Education/Experience
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities