Medical Policy Specialist researches and designs criteria to determine policy guidelines used in review of patient cases to ensure only medically appropriate services are reimbursed. Recommends a policy and process that ensure alignment with company guidelines and nationally accepted medical/coding standards. Being a Medical Policy Specialist establishes the proper codes to use for claims processing. Responds to questions from medical staff and communicates details about policy and guidelines. Additionally, Medical Policy Specialist requires a bachelor's degree. Typically reports to a supervisor or manager. Requires Registered Nurse RN. The Medical Policy Specialist gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Medical Policy Specialist typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
Work within the nursing process to provide direct nursing care to assigned patients consistent with clinical specialty (PCU/ICU/ED etc.), Serve as a role model to promote a positive work environment and quality patient care.
Ensure adherence to Hospitals and departmental policies and procedures. Minimum work requirement for RN Per Diem I is two shifts per schedule. One weekend shift per schedule and one summer and one winter holiday are required. Patient care assignment may include; Neonate, Pediatric, Adolescent, Adult and Geriatric age groups.Clear All
0 Medical Policy Specialist jobs found in Santa Fe, NM area