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)
Position: Community Health RN
Shift: Days
Guaranteed Hours: 40 hrs
Duration: 13 weeks
Weekly Gross: $ 3,040 (based on 40 hours)
Estimated NET: $ 2,804 (based on 40 hours)
Misc. and I E $ 800 (non-tax weekly)
Lodging $ 800 (weekly)
Hourly Rate: $36/hour
OT Rate: $ 85/hour (after 40 hours)
Weekly gross $ 3,720 (Based on 48 hours)
Est. Weekly Net $3,084 (Based on 48 hours)
The Community Health Nurse (CHN) provides, teaches, supervises and documents nursing care of the sick and injured at home.
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0 Staff Nurse - RN, Sr. - Medical Management jobs found in Pittsfield, MA area