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)
TLC Nurse Solutions is a family and women-owned registry, extending an invitation to qualified and compassionate Independent Contractor Registered Nurses to join our team. We offer access to a diverse array of assignments for registered nurses across California.
We are seeking a Registered Nurse for a prestigious Concierge Medical Office. This is a possible temp to perm full time position.
Responsibilities:
Requirements:
**This is a possible temp to perm position, with hours from 8:30 am to 5:00 pm, Monday through Friday." Serious applicants only
Job Type: Contract
Pay: $70.00 - $85.00 per hour
Expected hours: 40 per week
Standard shift:
Weekly schedule:
Application Question(s):
Experience:
License/Certification:
Work Location: In person
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0 Staff Nurse - RN, Sr. - Medical Management jobs found in San Jose, CA area