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 Description: Perform duties inherent to a RN in the respective department.
Qualifications: Graduate of an accredited school of nursing, and must hold current RN licensure in the state of Indiana. Possess Basic Life Support certification. Willingness to consult with physician, pharmacist, or other medical professional if need arises. Other certifications might be required depending on department policies.
Shift: Day
Ref Code: 14222
Contact Information: Dawn Kreft, Employment Coordinator – Human Resources
Email: dkreft@woodlawnhospital.com
Phone: 574-224-1102
Clear All
0 Staff Nurse - RN, Sr. - Medical Management jobs found in South Bend, IN area