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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Join our team as a night shift, full-time, Medical Surgical Registered Nurse in Pocatello, ID.
Fulfilling your purpose begins here:
People First, Always. Here’s how we take care of our people:
Your team is bigger than your department:
The Registered Nurse utilizes the knowledge basis of nursing education and experience in order to deliver nursing care using the nursing process according to hospital policies, procedures and protocols. The RN responds to life threatening situations with appropriate nursing interventions. The RN organizes care delivery by prioritizing, delegating, delivering, evaluating and communicating with all necessary Providers/Leaders on an ongoing basis.
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0 Staff Nurse - RN, Sr. - Medical Management jobs found in Pocatello, ID area