Medical Management Nurse I (Remote)

The Execu | Search Group
Published
April 9, 2021
Location
Indianapolis, IN
Category
Job Type

Description

A health services company in Indiana is currently seeking a licensed Registered Nurse (RN) to join their staff Remotely as their new Medical Management Nurse I. In this role, the Medical Management Nurse I (Remote) will be responsible for collaborating with healthcare providers and members to promote quality member outcomes, optimize member benefits, and promote effective use of resources.

Responsibilities:

The Medical Management Nurse I (Remote) will:

  • Conduct pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts
  • Ensures member access to medical necessary, quality healthcare in a cost effective setting according to contract
  • Consult with Clinical Reviewers and/or Medical Directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process
  • Collaborate with providers to assess members needs for early identification of and proactive planning for discharge planning
  • Facilitate member care transition through the healthcare continuum and refer treatment plans/plan of care to Clinical Reviewers
  • Facilitate accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards
  • Assist with other duties, as needed

Qualifications:

  • 2+ years of Acute Clinical Care experience
  • Associate's and/or Bachelor's Degree in a relate field
  • Active unrestricted Registered Nurse (RN)
  • Microsoft Office/Suite proficient
  • Solid assessment, clinical, and documentation skills
  • Great interpersonal skills
  • Excellent communication skills (written and verbal)
  • Strong attention to detail
  • Highly organized

Desired Skills:

  • Utilization Management background
  • Medicaid experience
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