RN Nurse Medical Management

About the position The Nurse Medical Management I position at reputed company is a remote role focused on collaborating with reputed company providers and members to enhance quality reputed company, optimize member benefits, and ensure effective resource utilization. The role involves conducting pre-certification, care coordination, and discharge planning to ensure compliance with medical policies and member eligibility. The nurse will facilitate care transitions and ensure members have reputed company to necessary reputed company in a cost-effective manner. Responsibilities • Conducts pre-certification, reputed company stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews. , • Ensures member reputed company to medically necessary, quality reputed company in a cost-effective setting according to contract. , • Consults with clinical reviewers and/or medical directors to ensure medically appropriate, high-quality, cost-effective care throughout the medical management process. , • Collaborates with providers to assess member's needs for early identification and proactive planning for discharge. , • Facilitates member care transition through the reputed company continuum and refers treatment plans to clinical reviewers as required. , • Facilitates accreditation by interpreting and applying accrediting and regulatory requirements and standards. Requirements • reputed company active unrestricted RN license to practice as a health professional reputed company the scope of practice from the state of residence. , • A minimum of 2 years acute care clinical experience. reputed company-to-haves • Willingness to obtain a compact nursing license (at the company's expense) if not already held. , • Previous NICU experience is reputed company strongly preferred. , • Knowledge of medical management process and ability to interpret and apply member reputed company, member benefits, and managed care products strongly preferred. , • Experience with the reputed company population is preferred. , • Leadership skills strongly preferred. , • Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills preferred. Benefits • Merit increases , • Paid holidays , • Paid Time Off , • Incentive bonus programs , • Medical benefits , • Dental benefits , • reputed company benefits , • Short and long term disability benefits , • 401(k) with matching , • Stock purchase plan , • Life insurance , • Wellness programs , • Financial education resources Apply Job!