Staff Nurse - RN, Sr. - Medical Management leads the coordination between care providers and plan members with the goal of maximizing member benefits while managing costs. Oversees the assessment of medical necessity of procedures and/or admissions, conducts pre-certification or authorization, and ensures compliance with established guidelines. Being a Staff Nurse - RN, Sr. - Medical Management assists members in appeals for denied services. Interprets benefits and guides members to choose to the appropriate providers, projects and resources. Additionally, Staff Nurse - RN, Sr. - Medical Management 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. To be a Staff Nurse - RN, Sr. - Medical Management 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. (Copyright 2024 Salary.com)
The Staff Nurse RN provides professional nursing care through the application of nursing skills and processes to develop, implement, and evaluate patients' plans of care while creating an atmosphere that supports our mission : To care, To heal, To educate.
The Staff Nurse RN, as the primary caregiver, provides direct patient care and works collaboratively with other care team members, the physician and the patient / family to achieve optimal patient outcomes.
The incumbent has access to confidential patient information and makes decisions independently and in collaboration with others.
The Staff Nurse, RN works under the direct supervision of the Nurse Manager and under the indirect supervision of the Director of Nursing.
Please note : Travelers may be asked to float to other locations. These locations include, Adena Greenfield, Adena Fayette and Adena Pike.
RN s will be floated to like areas. Will work every other weekend.
BLS, ACLS, and solid critical care background required