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)
Schedule: Mon-Fri 8a-4p
Start date: TBD.(after Apr-1)
Location: East Liberty, OH area
Contract Duration: 1.5 to 2 weeks.
Pay rate: $40/hr $100 Bonus per shift.
Your role is very simple and all small training needed will be given to you for this research. For more information, contact us at 614-Five89-Zero423 via text or call.
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0 Staff Nurse - RN, Sr. - Medical Management jobs found in Springfield, OH area