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)
Health Carousel - Travel RN is seeking a travel nurse RN Long Term Care for a travel nursing job in Irene, South Dakota.
Job Description & RequirementsHealth Carousel - Travel RN Job ID #JO Pay package is based on 12 hour shifts and 36 hours per week (subject to confirmation) with tax-free stipend amount to be determined.
About Health Carousel - Travel RNHealth Carousel is a healthcare staffing brand dedicated to providing excellent travel assignments for healthcare professionals. We work closely with medical and care facilities across the United States to fill vacant positions with highly talented medical staff in places that make a difference.
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