Patient Benefit and Care Nurse Coordinator II Jobs

The Patient Benefit and Care Nurse Coordinator II oversees the assessment of medical necessity of procedures and/or admissions, conducts pre-certification or authorization, and ensures compliance with established guidelines. Leads the coordination between care providers and plan members with the goal of maximizing member benefits while managing costs. Being a Patient Benefit and Care Nurse Coordinator II interprets benefits and guides members to choose to the appropriate providers, projects and resources. Assists members in appeals for denied services. In addition, Patient Benefit and Care Nur ... se Coordinator II 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. Working as a Patient Benefit and Care Nurse Coordinator II 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. More
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