Staff Nurse - RN - Medical Management
Also referred to as: Staff Nurse - RN - Medical Management, Staff Nurse - RN II - Medical Management, Mid Level Registered Nurse - Medical Management, Mid Level Nurse - Medical Management, Mid Level RN - Medical Management, Medical Management Nurse, RN Medical Management
Requirements and Responsibilities
Coordinates with care providers and plan members with the goal of maximizing member benefits while managing costs. 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. Typically requires a special degree of Nursing or its equivalent. Typically reports to a manager. Requires RN license. Typically requires 3-5 years of related experience. Gaining exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work.
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Level of Education:  Staff Nurse - RN - Medical Management Salaries with No Diploma, Staff Nurse - RN - Medical Management Salaries with a High School Diploma or Technical Certificate, Staff Nurse - RN - Medical Management Salaries with an Associate's Degree, Staff Nurse - RN - Medical Management Salaries with a Bachelor's Degree, Staff Nurse - RN - Medical Management Salaries with a Master's Degree or MBA, Staff Nurse - RN - Medical Management Salaries with a JD, MD, PhD or Equivalent
Categories:  Healthcare -- Nursing, Insurance, Non-Profit and Social Services
Industries:  Business Services, Edu., Gov't. & Nonprofit, Healthcare, Insurance,
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