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)
Kern Medical has been a community cornerstone since its founding in 1867. Today, we are an acute care teaching center with 222 beds, offering the only advanced trauma care between Fresno and Los Angeles. Each year, more than 200 residents, fellows, and medical students enroll in our UCLA-affiliated training programs, with residencies in internal medicine, family practice, emergency medicine, obstetrics and gynecology, and psychiatry. Many of the physicians trained at Kern Medical remain to practice in the community. We also promote the education of clinical pharmacists, nursing students, respiratory therapists, lab techs, and allied health professionals. Kern Medical offers a range of primary, specialty, and multi-specialty services, including high-risk pregnancy care, inpatient psychiatric services integrated with county mental health programs, and a growing network of outpatient clinics providing personalized patient-centered wellness care. We value innovation and continue to add new medical technologies, recruit outstanding physicians in new specialties, and strengthen our ties with UCLA. As a top-flight regional healthcare system, Kern Medical is a leading voice for health, healing, and wellness in the Central Valley.
Career Opportunities within Kern Medical for qualifying positions include many benefits, such as:
Position: Hospital Staff Nurse - Enhanced Care Management - Shift
Compensation
The estimated pay for this position is $41.3155 to $65.1007. The rates shown include a 6% premium pay (base= $-$ plus 6%). This reflects only a portion of the total compensation package for this position. Additional compensation may be available for this role through differentials, incentives, and bonuses. In addition, this position may be eligible for participation and company contributions to the Kern County Employees’ Retirement Plan.
Under the supervision of a nurse leader (Chief Nursing Officer, Clinical Director, Clinical Supervisor, and Clinical Nurse Leader), independently prescribes, delegates, and coordinates nursing care to the acutely ill patient and performs the nursing process through assessment, planning, implementation, and evaluation of safe, therapeutic care for patients. The scope of practice is in accordance with the ANA Scope and Standards of Practice, ANA Code of Ethics, and California Nurse Practice Act Board of Registered Nurses of the State of California.
Distinguishing Characteristics:
This classification ranges from novice nurses with limited knowledge and skills to expert nurses with advanced knowledge and skills and the ability to perform work with minimum supervision. It is designed to accommodate the expanding experience of the Registered Nurse (RN), resulting in the ability to orient nurses with limited experience and re-entry nurses to current clinical practice. The HSN is expected to be committed to enhancing the profession of nursing, actively seek to improve their professional practice, contribute to the professional development of others, demonstrate caring-healing practices and promote the vision and goals of the organization and Department of Nursing. All nursing clinical practice will be evaluated and governed by the Chief Nursing Officer (CNO) and/or their RN designee.
Essential Functions:
Other Functions:
Employment Standards:
Graduation from an accredited registered nursing program with a Bachelor's or Associate’s degree preferred and a valid and unrestricted license issued by the State of California to practice as a Registered Nurse; Or Possession of an active temporary license issued by the State of California to practice as a Registered Nurse.
Employees must maintain all health requirements designated by Kern Medical Center.
Possess and maintain a current American Heart Association Healthcare Provider Basic Life Support (BLS) card.
Depending on assignment, incumbents may be required to possess and maintain specific certificates of competency or complete designated education as a condition of employment.
Depending Upon Assignment:
Knowledge of:
Skill in:
Following oral and written instructions and maintaining concise and complete records. Demonstrate the practical and theoretical knowledge of nursing care specific to the assigned work area/specialty; meet the content and performance criteria specific to each defined specialty, including the nursing process, leadership/professional development, and unit operation; demonstrate standard techniques of record maintenance and report writing; using computers and related software applications; keyboarding and using standard office equipment; follow oral and written instruction; communicate both orally and in writing sufficient to exchange or convey information and to receive work direction; prepare and maintain concise and comprehensive required records and reports; establish and maintain effective work relationships with staff, other hospital employees, patients, and their families; dependent upon the area of practice or department assignments, demonstrates clinical knowledge and skill in the care of populations served by Kern Medical facilities.
Supplemental:
A background check may be required for this classification.
All Kern Medical employees are designated “Disaster Service Workers.” In the event of a disaster or civil disorder, all Kern Medical employees are to remain at work or to report to work in a safe and practicable manner.
If position responsibilities require driving a personal vehicle, then possession of a current valid California Driver’s License and adherence to the Kern County Hospital Authority Vehicle Use and Driving Standard Policy (ENG-EC-119) is required.
If position responsibilities require driving a vehicle owned, leased, or rented by Kern Medical, then possession of a current valid California Driver’s license, a signed authorization for Release of Drivers Record Information, and adherence to the Kern County Hospital Authority Vehicle Use and Driving Standard Policy (ENG-EC-119) is required.
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