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)
**THIS IS A PAY-PER-VISIT (UNIT) POSITION**
Job Summary: Provides prescribed nursing care services to ill, injured, convalescent and disabled persons in a home setting, functioning independently without on-site supervision.
Essential Functions:
Additional Responsibilities:
Knowledge / Skills / Abilities:
Age-Related Competencies:
Demonstrates the basic knowledge and skills necessary to identify age specific patient needs appropriate for this position.
Information Management:
Treats all information and data, within the scope of the position, with appropriate confidentiality and security.
Risk Management:
Minimum Position Qualifications:
o Graduate of an accredited school of nursing
o 1 year experience in nursing
o Appropriate competency assessments completed
o Current Texas RN license
o Current Texas driver’s license
o Current Automobile liability insurance
Environmental Conditions:
The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities.
Job Type: Full-time
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0 Staff Nurse - RN, Sr. - Medical Management jobs found in Galveston, TX area