Skills & Competencies for Staff Nurse - RN, Sr. - Medical Management

Staff Nurse - RN, Sr. - Medical Management job profile

JOB SUMMARY for 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.

JOB RESPONSIBILITIES for Staff Nurse - RN, Sr. - Medical Management

Oversees the assessment of medical necessity of procedures and/or admissions, conducts pre-certification or authorization, and ensures 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. Applies the medical and reimbursement policies within the claim adjudication process.

Staff Nurse - RN, Sr. - Medical Management SALARY RANGE

BASE 50%
$96,386
TOTAL 50%
$100,848
Job Level
P03
Job Code
HC07000622
Education/Degree
Bachelor's Degree
Reports To
Manager

Staff Nurse - RN, Sr. - Medical Management Skills and Competencies List

Proficiency Levels and Behavioural Indicators
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 Staff Nurse - RN, Sr. - Medical Management skill and competencie below to view definitions.

9 general skills or competencies (Job family competencies) for Staff Nurse - RN, Sr. - Medical Management

1 Job Family Competencies – Healthcare Industry
Proficiency Level -2
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)
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 -3
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)
Describes the importance and the role of knowledge management within the healthcare industry.
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Level 2 Behaviors
(Light Experience)
Identifies critical competencies and relevant resources to support healthcare advancements.
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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)
Develops and delivers educational programs for employees to improve our healthcare service delivery.
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3 Staff Nurse - RN, Sr. - Medical Management - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Staff Nurse - RN, Sr. - Medical Management
Proficiency Level - 4
5 Competency for - Staff Nurse - RN, Sr. - Medical Management
Proficiency Level - 5

6 soft skills or competencies (core competencies) for Staff Nurse - RN, Sr. - Medical Management

1 Core Competencies – Attention to Detail
Proficiency Level -3
Skill definition-Executing and completing a task with a high level of accuracy.
Level 1 Behaviors
(General Familiarity)
Identifies the procedures for making sure that results are mistake-free.
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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)
Reviews and analyzes the accuracy of data and details.
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Level 4 Behaviors
(Extensive Experience)
Designs systems to help the team organize and track details and project progress.
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Level 5 Behaviors
(Mastery)
Develops best practices for identifying and correcting errors, oversights, and omissions.
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2 Core Competencies – Time Management
Proficiency Level -3
Skill definition-Managing and setting priorities, goals, and timetables to boost productivity and efficiency in completing tasks.
Level 1 Behaviors
(General Familiarity)
Discusses workplace barriers and issues that may affect time management.
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Level 2 Behaviors
(Light Experience)
Collects and compiles information in an organized manner to finish tasks efficiently.
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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)
Improves processes to organize workloads of teams efficiently.
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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, Sr. - Medical Management - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Staff Nurse - RN, Sr. - Medical Management
Proficiency Level - 4
5 Competency for - Staff Nurse - RN, Sr. - Medical Management
Proficiency Level - 5

Summary of Staff Nurse - RN, Sr. - Medical Management skills and competencies

There are 0 hard skills for Staff Nurse - RN, Sr. - Medical Management.
9 general skills for Staff Nurse - RN, Sr. - Medical Management, Healthcare Industry, Healthcare Knowledge, Healthcare Regulatory Environment, etc.
6 soft skills for Staff Nurse - RN, Sr. - Medical Management, Attention to Detail, Time Management, Problem Solving, etc.
While the list totals 15 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, Sr. - Medical Management, he or she needs to be skilled in Attention to Detail, be skilled in Time Management, and be proficient in Problem Solving.

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