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)
5 of 10 Positions Open
4 Day Shifts (7A-7:30P)
1 Night Shifts (7P-7:30A)
* *** REQUIRED: PROOF of COVID & FLU vaccination OR Declination form MUST be uploaded to candidate profile at time of submission.****
***Please note: Client requires a full Hep B series (3 doses) or positive Hep B antibody documentation**
Responsibilities:
Provides professional nursing care through skillful assessment, diagnosis, outcomes identification, planning, implementation, and evaluation in accordance with facility or department policies and procedures. Directs and manages the care of designated patients. Utilizes effective and appropriate communication styles. Assists in maintaining a safe work environment and maintains clinical and professional competency as appropriate to the population of patients served.
Certifications - Required
AHA BLS - Basic Life Support Certificate
NIHSS Certificate
Education - Required
Graduate of accredited Nursing program
Experience - Required
1 year Acute Care Experience and/or experience congruent with role in service line
Licenses - Required
Registered Nurse State of Pennsylvania
Knowledge, Skills and Abilities - Required
Successful completion of Registered Nurse orientation.
Knowledge and competence that reflects current nursing practice.
Ability to organize and prioritize assignments in the delivery of patient care.
Successful completion of additional orientation programs related to specialty.
Attainment and maintenance of unit-specific competencies.
Basic computer skills.
Ann Dizon
Account Manager
317 328 2866
ann@rnstaff.com
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