| Registered Nurse II - Medical Management Job Description |
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| The following is a full job description for Registered Nurse II - Medical Management. Here are the requirements and responsibilities for Registered Nurse II - Medical Management along with statistics. If after reading this page you determine that Registered Nurse II - Medical Management is not the position you are looking for, you may want to try one of these similar titles: Registered Nurse II - Medical Management, Registered Nurse III - Medical Management, Staff Nurse - RN II, Telemedicine Registered Nurse, Staff Nurse - RN III, Registered Nurse - Phone Triage, Licensed Practical Nurse - Medical Management, Medical Management Director, Medical Management Manager, Master Data Management Analyst II |
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| Requirements and Responsibilities For Registered Nurse II - Medical Management |
| Responsible for coordinating with healthcare providers and plan members to maximize member benefits while managing costs. Assesses medical necessity of patient admissions, surgical and diagnostic procedures, and other related services. Conducts pre-certification and/or authorization, and monitors compliance with established medical guidelines and policies. May assist members in appeals for denied services. Applies the medical and reimbursement policies within the claim adjudication process. Typically requires a bachelor's degree in nursing. Requires Registered Nurse (RN). Typically reports to a manager. Occasionally directed in several aspects of the work. Gaining exposure to some of the complex tasks within the job function. Typically requires 2-4 years of related experience. |
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| Also referred to as: Nurse Manager, Member Benefit Coordination, Patient Benefit and Care Nurse Coordinator I, Patient Care Authorization Nurse, Staff Nurse - RN - Medical Management |
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| Similar Jobs: Registered Nurse II - Medical Management, Registered Nurse III - Medical Management, Staff Nurse - RN II, Telemedicine Registered Nurse, Staff Nurse - RN III, Registered Nurse - Phone Triage, Licensed Practical Nurse - Medical Management, Medical Management Director, Medical Management Manager, Master Data Management Analyst II |
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| Level of Education: Registered Nurse II - Medical Management Salaries with No Diploma, Registered Nurse II - Medical Management Salaries with a High School Diploma or Technical Certificate, Registered Nurse II - Medical Management Salaries with an Associate's Degree, Registered Nurse II - Medical Management Salaries with a Bachelor's Degree, Registered Nurse II - Medical Management Salaries with a Master's Degree or MBA, Registered Nurse II - Medical Management Salaries with a JD, MD, PhD or Equivalent |
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| Industries: Business Services, Edu., Gov't. & Nonprofit, Healthcare, Insurance | |
