Coordinates with care providers and plan members with the goal of maximizing member benefits while managing costs.
Assesses medical necessity of procedures and/or admissions, conducts pre-certification or authorization, and monitors compliance with established guidelines. Assists members in appeals for denied services. Interprets benefits and guides members to choose to the appropriate providers, projects and resources.
Salary.com identifies five increasing levels of proficiency for each skill/competency. Some jobs require only a relatively low level of proficiency in each skill/competency, while other jobs will require a more advanced level of proficiency in the same skill/competency. These levels rate the degree of proficiency (skill level, expertise) we expect the incumbent to perform in the given skill/competency for the given job. Note that we intentionally do not associate timeframes or years of experience in performing the skill/competency because that can be misleading. Proficiency levels identify what the incumbent knows and can do rather than how long they have been doing it. Also, note that the proficiency levels are cumulative, e.g., a level 4 proficiency implies the ability to perform all the behaviors at the lower levels.
Check each Registered Nurse II - Medical Management skill and competencie below to view definitions.
Skill definition-Applying healthcare industry knowledge to manufacture drugs and equipment and offer clinical and other healthcare-related support services.
Level 1 Behaviors
(General Familiarity)
Explains the clinical benefits of integrating innovations and technological advances into healthcare services.
Level 2 Behaviors
(Light Experience)
Supports the development of innovative healthcare practices to reduce healthcare costs.
Level 3 Behaviors
(Moderate Experience)
Researches technical developments in the healthcare industry and assesses their implications for our organization.
Level 4 Behaviors
(Extensive Experience)
Integrates advanced processes into clinical workflows to diagnose and treat diseases more precisely.
Level 5 Behaviors
(Mastery)
Leads the development of services and solutions to address complex healthcare industry challenges.
Skill definition-Utilizing and sharing knowledge of healthcare practices, processes, systems, and procedures to provide high-quality services to patients.
Level 1 Behaviors
(General Familiarity)
Explains the importance of healthcare services in disease prevention and control.
Level 2 Behaviors
(Light Experience)
Records healthcare information using different mediums for transmission.
Level 3 Behaviors
(Moderate Experience)
Utilizes specialized healthcare equipment to ensure seamless monitoring of patients' status.
Level 4 Behaviors
(Extensive Experience)
Monitors emerging healthcare trends and assesses their implications for the organization's performance.
Level 5 Behaviors
(Mastery)
Establishes a "knowledge-sharing" environment to contribute to breakthroughs in the healthcare service industry.
Skill definition-Executing and completing a task with a high level of accuracy.
Level 1 Behaviors
(General Familiarity)
Lists best practices and tools to maintain high accuracy and thoroughness in the workplace.
Level 2 Behaviors
(Light Experience)
Uses checklists to ensure that information goes out error-free.
Level 3 Behaviors
(Moderate Experience)
Sets up processes to ensure delivery of high-quality work.
Level 4 Behaviors
(Extensive Experience)
Employs techniques for motivating personnel to meet or exceed accuracy goals.
Level 5 Behaviors
(Mastery)
Leads the creation of tools for enhancing and assuring accuracy.
Skill definition-Managing and setting priorities, goals, and timetables to boost productivity and efficiency in completing tasks.
Level 1 Behaviors
(General Familiarity)
Explains the importance of time management in driving the overall productivity of our business.
Level 2 Behaviors
(Light Experience)
Employs the 80-20 rule to avoid perfectionism and minimize time-wasting.
Level 3 Behaviors
(Moderate Experience)
Utilizes departmental tools and best practices to organize tasks effectively and productively.
Level 4 Behaviors
(Extensive Experience)
Manages teams in streamlining work-related tasks to prioritize highest value tasks firsts.
Level 5 Behaviors
(Mastery)
Leads transformational changes to work plans to drive the proper utilization of time and resources.
There are 0 hard skills for Registered Nurse II - Medical Management.
9 general skills for Registered Nurse II - Medical Management, Healthcare Industry, Healthcare Knowledge, Healthcare Regulatory Environment, etc.
5 soft skills for Registered Nurse II - Medical Management, Attention to Detail, Time Management, Initiative, etc.
While the list totals 14 distinct skills, it's important to note that not all are required to be mastered to the same degree. Some skills may only need a basic understanding, whereas others demand a higher level of expertise.
For instance, as a Registered Nurse II - Medical Management, he or she needs to be proficient in Attention to Detail, be proficient in Time Management, and be proficient in Initiative.
