Skills & Competencies for Staff Nurse - RN - Medical Management
Staff Nurse - RN - Medical Management job profile
Book a Demo and Receive a Sample Job ProfileJOB SUMMARY for Staff Nurse - RN - Medical Management
Coordinates with care providers and plan members with the goal of maximizing member benefits while managing costs.
JOB RESPONSIBILITIES for Staff Nurse - RN - Medical Management
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.
Staff Nurse - RN - Medical Management SALARY RANGE
BASE 50%
$86,411
TOTAL 50%
$89,745
Job Level
P02
Job Code
HC07000621
Education/Degree
Bachelor's Degree
Reports To
Manager
Staff Nurse - RN - Medical Management Skills and Competencies List
9 general skills or competencies (Job family competencies) for Staff Nurse - RN - Medical Management
1
Job Family Competencies –
Healthcare Industry
Proficiency Level -2
Level 1 Behaviors
(General Familiarity)
Compiles a list of risks and regulatory challenges for healthcare industries.
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Level 2 Behaviors
(Light Experience)
Assists in implementing industry best practices to secure and protect confidential healthcare information.
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Level 3 Behaviors
(Moderate Experience)
Communicates healthcare policies and procedures to ensure compliance with professional practice standards.
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Level 4 Behaviors
(Extensive Experience)
Delivers healthcare education and training programs to bridge skill gaps in our organization.
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Level 5 Behaviors
(Mastery)
Designs and implements cost-effective strategies to optimize resource utilization within healthcare settings.
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2
Job Family Competencies –
Healthcare Knowledge
Proficiency Level -2
Level 1 Behaviors
(General Familiarity)
Describes the distinction between tacit and explicit knowledge of healthcare operations.
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Level 2 Behaviors
(Light Experience)
Follows healthcare guidelines, procedures, and standards when providing medical care services.
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Level 3 Behaviors
(Moderate Experience)
Participates in public discussions to raise awareness on health issues, technologies, or advancements.
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Level 4 Behaviors
(Extensive Experience)
Guides healthcare staff on how to operate and maintain healthcare knowledge management systems.
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Level 5 Behaviors
(Mastery)
Designs efficient research methodologies to stay current with the latest healthcare trends and best practices.
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3
Staff Nurse - RN - Medical Management
- Skill and Competency
Proficiency Level - 3
4
Skill and Competency -
Staff Nurse - RN - Medical Management
Proficiency Level - 4
5
Competency for -
Staff Nurse - RN - Medical Management
Proficiency Level - 5
5 soft skills or competencies (core competencies) for Staff Nurse - RN - Medical Management
1
Core Competencies –
Attention to Detail
Proficiency Level -2
Level 1 Behaviors
(General Familiarity)
Explains why attention to detail plays an important role in own function or unit.
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Level 2 Behaviors
(Light Experience)
Processes limited amounts of detailed information with reasonable accuracy.
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Level 3 Behaviors
(Moderate Experience)
Processes large quantities of detailed information with high levels of accuracy.
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Level 4 Behaviors
(Extensive Experience)
Demonstrates expertise in quality assurance tools, techniques, and standards.
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Level 5 Behaviors
(Mastery)
Designs techniques for measuring the cost and impact of errors.
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2
Core Competencies –
Time Management
Proficiency Level -2
Level 1 Behaviors
(General Familiarity)
Describes how to utilize a time management matrix for efficient completion of most important tasks.
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Level 2 Behaviors
(Light Experience)
Classifies assigned tasks into specific, smaller, and more achievable goals.
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Level 3 Behaviors
(Moderate Experience)
Executes work plans to manage workflow and track milestones to completion.
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Level 4 Behaviors
(Extensive Experience)
Develops best techniques and methods to improve time management throughout our business.
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Level 5 Behaviors
(Mastery)
Establishes a time management matrix to reprioritize the importance of current and upcoming tasks.
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3
Staff Nurse - RN - Medical Management
- Skill and Competency
Proficiency Level - 3
4
Skill and Competency -
Staff Nurse - RN - Medical Management
Proficiency Level - 4
5
Competency for -
Staff Nurse - RN - Medical Management
Proficiency Level - 5
Summary of Staff Nurse - RN - Medical Management skills and competencies
There are 0 hard skills for Staff Nurse - RN - Medical Management.
9 general skills for Staff Nurse - RN - Medical Management, Healthcare Industry, Healthcare Knowledge, Healthcare Regulatory Environment, etc.
5 soft skills for Staff Nurse - RN - 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 Staff Nurse - RN - Medical Management, he or she needs to be proficient in Attention to Detail, be proficient in Time Management, and be proficient in Initiative.
9 general skills for Staff Nurse - RN - Medical Management, Healthcare Industry, Healthcare Knowledge, Healthcare Regulatory Environment, etc.
5 soft skills for Staff Nurse - RN - 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 Staff Nurse - RN - Medical Management, he or she needs to be proficient in Attention to Detail, be proficient in Time Management, and be proficient in Initiative.
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