Staff Nurse - RN - Medical Management Jobs

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. More
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