| Registered Nurse III - Medical Management Job Description |
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| The following is a full job description for Registered Nurse III - Medical Management. Here are the requirements and responsibilities for Registered Nurse III - Medical Management along with statistics. If after reading this page you determine that Registered Nurse III - Medical Management is not the position you are looking for, you may want to try one of these similar titles: Registered Nurse III - Medical Management, Registered Nurse II - Medical Management, Staff Nurse - RN III, Telemedicine Registered Nurse, Staff Nurse - RN II, Registered Nurse - Phone Triage, Licensed Practical Nurse - Medical Management, Medical Affairs Specialist III, Medical Writer III, Medical Management Director |
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| Requirements and Responsibilities For Registered Nurse III - 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. Work is generally independent and collaborative in nature. Contributes to moderately complex aspects of a project. Typically requires 4-7 years of related experience. |
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| Also referred to as: Patient Benefit and Care Nurse Coordinator II, Patient Care Authorization Senior Nurse, Senior Nurse Manager, Care Coordination, Senior Nurse Manager, Member Benefit Coordination, Staff Nurse - RN, Sr. - Medical Management |
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| Similar Jobs: Registered Nurse III - Medical Management, Registered Nurse II - Medical Management, Staff Nurse - RN III, Telemedicine Registered Nurse, Staff Nurse - RN II, Registered Nurse - Phone Triage, Licensed Practical Nurse - Medical Management, Medical Affairs Specialist III, Medical Writer III, Medical Management Director |
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| Level of Education: Registered Nurse III - Medical Management Salaries with No Diploma, Registered Nurse III - Medical Management Salaries with a High School Diploma or Technical Certificate, Registered Nurse III - Medical Management Salaries with an Associate's Degree, Registered Nurse III - Medical Management Salaries with a Bachelor's Degree, Registered Nurse III - Medical Management Salaries with a Master's Degree or MBA, Registered Nurse III - Medical Management Salaries with a JD, MD, PhD or Equivalent |
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| Industries: Business Services, Edu., Gov't. & Nonprofit, Healthcare, Insurance | |
