Staff Nurse - RN, Sr. - Medical Management jobs in Galveston, TX

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)

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Home Health: Registered Nurse (RN)
  • Coastal Staff Relief, Inc.
  • Jackson, TX FULL_TIME
  • **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:

    • Demonstrates the ability to transfer scientific knowledge from social, biological, and physical sciences in applying the nursing process.
    • Demonstrates knowledge and competency in performing baseline nursing skills. Maintains clinical competencies according to agency standards.
    • Administers all medications and treatments according to agency policy and procedure, accepted standards of care and agency guidelines.
    • Communicates effectively with patients, families, and physicians.
    • Performs accurate assessments, develops and implements a written Plan of Care with the patient, following physician’s orders and according to agency guidelines. Performs and documents nursing interventions including patient education according to the Plan of Care and adapts these actions as patient needs change.
    • Documents patient status in an accurate, timely and concise manner as required by agency policy. Addresses patient needs and problems, nursing intervention and patient response, safety interventions and education and teaching
    • Demonstrates organization and leadership abilities by effective use of time and personnel through supervision and teaching. Effectively establishes priorities and delegates responsibilities appropriately when supervising the LVN and the HCA
    • Maintains a committed and cooperative attitude with staffing, promoting teamwork and harmony by readily assisting other staff and patients. Participates in case conferences/team meetings.
    • Makes visits as scheduled and participates in on-call rotation as required.

    Additional Responsibilities:

    • Performs other duties as assigned or requested.
    • Possesses adequate knowledge of Medicare/Medicaid and insurance standards to ensure reimbursement for all services rendered.
    • Conforms to all applicable agency policies and procedures.
    • Participates actively in continuing education and in-services.
    • Maintains confidentiality of patient information and business trade practices.
    • Assumes responsibility for reporting incidents and complaints according to agency policy.

    Knowledge / Skills / Abilities:

    • Advanced communication skills (verbal and written)
    • Organizational skills
    • Ability to supervise in accordance with agency’s policies and applicable laws
    • Advanced math skills related to patient care
    • Ability to respond to common inquiries or complaints, regulatory agencies or members of the business community.
    • Time management
    • Cooperative attitude
    • Advanced interpersonal communication (written and verbal)

    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:

    • Cooperates fully in all risk management activities and investigations.
    • Keeps abreast in changes in health care law.
    • Maintains agency/program compliance with local, state, and federal laws and accreditation standards.

    Minimum Position Qualifications:

    • Education:

    o Graduate of an accredited school of nursing

    • Experience:

    o 1 year experience in nursing

    • Training:

    o Appropriate competency assessments completed

    • License/Certifications:

    o Current Texas RN license
    o Current Texas driver’s license
    o Current Automobile liability insurance
    Environmental Conditions:

    • Moderate noise level
    • Category A BBP risk
    • Moderate stress and emotional demands

    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

  • 8 Days Ago

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Nurse Residency Program, Summer 2024 Cohort - RN New Grads
  • RN New Grads - UTMB Health Careers
  • Galveston, TX FULL_TIME
  • The UTMB Nurse Residency Program provides nurse residents with the resources and support needed to transition into independent practice. Available nurse clinician I positions are posted at the unit le...
  • 21 Days Ago

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Med/Surg RN - Medical Surgical - Travel Nurse
  • Fusion Medical Staffing
  • Bay, TX FULL_TIME,CONTRACTOR
  • Job DescriptionInterested in making a positive impact? You’ve come to the right place. At Fusion Medical Staffing, our goal is to improve the lives of everyone we touch, and we’re always looking for p...
  • 15 Days Ago

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RN Registered Nurse Freestanding ER
  • O'Mally Management Group
  • Galveston, TX FULL_TIME
  • Job Description for RN Registered Nurse Freestanding ER Hospitality Health ER is a freestanding ER located on the Seawall in Galveston, TX. We are currently hiring PRN and Full-Time Registered Nurses ...
  • 17 Days Ago

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Travel Nurse RN
  • Aureus Medical Group - Nursing
  • Bay, TX FULL_TIME
  • Aureus Medical Group - Nursing is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Bay City, Texas. Job Description & Requirements Specialty: ED - Emergency Department D...
  • 23 Days Ago

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Registered Nurse (RN)
  • FCM Group, LLC dba Nurse Next Door - Pearland &...
  • Freeport, TX FULL_TIME
  • Benefits/Perks Flexible Scheduling Competitive Compensation Careers Advancement Job Summary We are seeking a Registered Nurse to join our team. In this role, you will primarily be creating and managin...
  • 17 Days Ago

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0 Staff Nurse - RN, Sr. - Medical Management jobs found in Galveston, TX area

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Assistant Professor (N-T Trk Clin), Surgery-Vascular
  • UTMB Health
  • Galveston, TX
  • ESSENTIAL JOB FUNCTIONS: The purpose of this position is to provide faculty support to meet the teaching, research, and ...
  • 4/23/2024 12:00:00 AM

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Assistant Professor (N-T Trk Clin), Surgery-Cardiothoracic Surgery
  • UTMB Health
  • Galveston, TX
  • ESSENTIAL JOB FUNCTIONS: The person in this position is responsible for providing direct patient care, including surgery...
  • 4/23/2024 12:00:00 AM

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Assistant Professor - Ophthalmology - Oculoplastic
  • Utmb Health
  • Galveston, TX
  • JOB DESCRIPTION:The purpose of this position is to provide faculty support to meet the teaching, research and patient ca...
  • 4/22/2024 12:00:00 AM

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Assistant Professor (N-T Trk Clin), Surgery-Plastic Surgery
  • UTMB Health
  • Galveston, TX
  • ESSENTIAL JOB FUNCTIONS: The purpose of this position is to provide faculty support to meet the teaching, research, and ...
  • 4/21/2024 12:00:00 AM

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Assistant Professor - Otolaryngology
  • UTMB Health
  • Galveston, TX
  • ESSENTIAL JOB FUNCTIONS: The person in this position is responsible for providing direct patient care, specializing in o...
  • 4/21/2024 12:00:00 AM

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Assistant Professor - Orthopedic Surgery
  • University of Texas Medical Branch
  • Galveston, TX
  • JOB DESCRIPTION: The purpose of this position is to provide faculty support to meet the teaching, research and patient c...
  • 4/20/2024 12:00:00 AM

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Professor, Surgery-Transplant
  • UTMB Health
  • Galveston, TX
  • JOB DESCRIPTION: The purpose of this position is to provide faculty support to meet the teaching, research, and patient ...
  • 4/20/2024 12:00:00 AM

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Travel Nurse RN - CVOR - $2,337 per week
  • Hiring Now!
  • Webster, TX
  • TotalMed Staffing is seeking a travel nurse RN CVOR for a travel nursing job in Webster, Texas. Job Description & Requir...
  • 4/20/2024 12:00:00 AM

The city of Galveston is situated on Galveston Island, a barrier island off the Texas Gulf coast near the mainland coast. Made up of mostly sand-sized particles and smaller amounts of finer mud sediments and larger gravel-sized sediments, the island is unstable, affected by water and weather, and can shift its boundaries through erosion. The city is about 45 miles (72 km) southeast of downtown Houston. The island is oriented generally northeast-southwest, with the Gulf of Mexico on the east and south, West Bay on the west, and Galveston Bay on the north. The island's main access point from the...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Staff Nurse - RN, Sr. - Medical Management jobs
$89,893 to $112,321
Galveston, Texas area prices
were up 1.2% from a year ago