| Staff Nurse - RN - Medical Management Job Description |
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| The following is a full job description for Staff Nurse - RN - Medical Management. Here are the requirements and responsibilities for Staff Nurse - RN - Medical Management along with statistics. If after reading this page you determine that Staff Nurse - RN - Medical Management is not the position you are looking for, you may want to try one of these similar titles: Staff Nurse - RN - Medical Management, Staff Nurse - RN II, Staff Nurse - RN III, Staff Nurse - RN - Occupational Health, Staff Nurse Senior- RN - Occupational Health, Staff Nurse - RN, Sr. - Medical Management, Staff Nurse - RN - Dialysis, Staff Nurse - RN - Flight Transport, Staff Nurse - RN I, Staff Nurse - RN - CCU |
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| Requirements and Responsibilities For Staff Nurse - RN - Medical Management |
| 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 bachelor's degree in nursing. Typically reports to a manager. Requires a valid state RN license. Typically requires 3-5 years of related experience. Gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. |
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| Also referred to as: Nurse Manager, Member Benefit Coordination, Patient Benefit and Care Nurse Coordinator I, Patient Care Authorization Nurse |
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| Similar Jobs: Staff Nurse - RN - Medical Management, Staff Nurse - RN II, Staff Nurse - RN III, Staff Nurse - RN - Occupational Health, Staff Nurse Senior- RN - Occupational Health, Staff Nurse - RN, Sr. - Medical Management, Staff Nurse - RN - Dialysis, Staff Nurse - RN - Flight Transport, Staff Nurse - RN I, Staff Nurse - RN - CCU |
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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 |
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| Industries: Business Services, Edu., Gov't. & Nonprofit, Healthcare, Insurance | |
