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)
New Hire Rate: (Make up To $45/hr) Sign on Bonus $10,000
We offer the Following:
Covid 19 Vaccine: Required
Benefits:
Job Summary
The Staff Nurse RN, under the supervision of a Registered Nurse (RN), provides direct resident care as delegated , to include treatments and medication passes, and assists the RN in the delivery of resident care utilizing the nursing process as appropriate to the geriatric and short term rehabilitation residents. Participants in resident care services as directed by a supervisor in accordance with in-service training.
Education & Experience
Functions
ACKNOWLEDGEMENT
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. All pay rates and bonuses are paid and/ or awarded to employees based on the facilities policy and/ or the CBA, depending on the position.
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0 Staff Nurse - RN, Sr. - Medical Management jobs found in Binghamton, NY area