Staff Nurse - RN, Sr. - Medical Management jobs in the United States

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)

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WY - Medical/Surgical RN
  • RN Staff
  • Wyoming, WY FULL_TIME
  • POSITION SUMMARY
    The Registered Nurse provides and coordinates patient care through assessment, evaluation and treatment with a primary goal of achieving wellness and recovery.
    ESSENTIAL FUNCTIONS
    Assessment, evaluation, and implementation of patient needs, education, and care plans based on patient condition and diagnosis.
    Provides education to patients according to their needs.
    Transcribes, utilizes and implements protocols and physician orders.
    Collaboration with interdisciplinary teams to coordinate care, including case management, social work, dietary, cardiopulmonary, physical, occupational, and speech therapy.
    Continuous monitoring of patients.
    Assessment and monitoring of Telemetry Data
    Recognition of acute changes & deteriorations of patients with implementation of appropriate treatments.
    Other duties as assigned.
    EDUCATION

    Graduation
    of an accredited school of nursing required.
    EXPERIENCE

    4 years previous RN experience required
    CREDENTIALS

    Must
    have a current, valid RN license from the State of Wyoming and must be in good
    standing with the Board of Nursing.

    Must
    have current, valid Basic Life Support (BLS) certification.
    Must have current, valid Advanced Cardiac Life Support (ACLS) certification.

    Must
    complete telemetry course or demonstrate competency.
    KNOWLEDGE, SKILLS AND ABILITIES

    Annual
    completion of yearly required CEUs.

    Familiarity
    with IV drips (antibiotic, heparin, etc.).

    Excellent customer service skills, including
    but not limited to: a friendly personality, tact, patience, empathy and a
    helpful, professional attitude both in person and on the telephone.

    Ability to effectively communicate with staff,
    managers and the general public verbally and in writing.

    Demonstrate effective listening skills.

    Excellent organization and time management
    skills and ability to establish priorities effectively.

    Possess exceptional problem solving skills.

    Ability to work effectively without immediate
    supervision.

    Ability to learn new computer software programs.

    Ability to recognize and protect confidential
    information.

    Demonstrate ethical and legal accountability
    for the position.

    36
  • 19 Days Ago

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AZ - RN Case Management/Utilization Review
  • RN Staff
  • Yuma, AZ FULL_TIME
  • *******Fingerprinting must be submitted and cleared prior to start!***** **PLEASE SUBMIT CURRENT ADDRESS FOR FINGERPRINT PACKET TO BE MAILED VIA FEDERAL EXPRES** Please submit only if Tuba City housin...
  • 1 Month Ago

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Certified medical assistant
  • RN Staff
  • Bartlesville, OK FULL_TIME
  • 5k sign on, 10 k relocation SEARHC is a non-profit health consortium which serves the health interests of the residents of Southeast Alaska. We see our employees as our strongest assets. It is our pri...
  • 19 Days Ago

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INTERNATIONAL USRN Medical Pediatric in Oklahoma
  • RN Staff
  • Ardmore, OK FULL_TIME
  • Welcome to RNstaff, where compassion connects careers. We're not just a recruiting company; we're people who care about people. Join us in shaping the future of healthcare together. International RN O...
  • 24 Days Ago

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INTERNATIONAL USRN Medical Surgical at Missouri
  • RN Staff
  • St. Louis, MO FULL_TIME
  • Welcome to RNstaff, where compassion connects careers. We're not just a recruiting company; we're people who care about people. Join us in shaping the future of healthcare together. International RN O...
  • 18 Days Ago

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Weekend Option - Staff Nurse - Medical Surgical Float RN (CRU 4) Days
  • Staff Nurse - Medical Surgical Float RN (CRU 4) Days - Jobs@UIOWA Careers
  • Iowa, IA FULL_TIME
  • Qualified candidates with a minimum of two years of experience are eligible for a sign-on bonus up to $12,500 The University of Iowa Hospitals and Clinics Department of Nursing is seeking a Clinical R...
  • 1 Month Ago

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LPNs & RNs
  • MANIFEST-STAFF MEDICAL LLC
  • Columbus, OH
  • Job Description Job Description We are hiring LPNs & RNs for our staffing agency as the demand for our service is increa...
  • 10/31/2024 12:00:00 AM

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Staff Nurse - Emergency Nights 7p-7a - RN, ED
  • LMHS
  • Newark, OH
  • STAFF NURSEEMERGENCY DEPARTMENT Licking Memorial Health Systems (LMHS) is a leading, non-profit healthcare organization,...
  • 10/31/2024 12:00:00 AM

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Staff Nurse, RN - 4 West Med Surg (Nights)
  • LMHS
  • Newark, OH
  • STAFF NURSE 4 West Licking Memorial Health Systems (LMHS) is a leading, non-profit healthcare organization, passionately...
  • 10/31/2024 12:00:00 AM

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OH- Med/Surg Staff Nurse RN - Adena Fayette- Nights
  • HexaQuEST Global - Healthcare
  • Washington Court House, OH
  • Job Description: The Staff Nurse, RN provides professional nursing care through the application of nursing skills and pr...
  • 10/31/2024 12:00:00 AM

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Registered Nurse - Radiology
  • LMHS
  • Newark, OH
  • Staff Nurse Radiology Position Summary Under the general supervision of the physician and/or Director of Radiology Servi...
  • 10/31/2024 12:00:00 AM

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Psychiatric Care Technician - 2NP Adult Inpatient - Harding Hospital
  • The Ohio State University
  • Columbus, OH
  • Screen reader users may encounter difficulty with this site. For assistance with applying, please contact hr-accessiblea...
  • 10/30/2024 12:00:00 AM

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Staff Nurse - 5 East Med/Surg Post Surgical (Days)
  • LMHS
  • Newark, OH
  • STAFF NURSE 5 East - INPATIENT MED/SURG POST SURGICAL UNIT Licking Memorial Health Systems (LMHS) is a leading, non-prof...
  • 10/29/2024 12:00:00 AM

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RN Clinical Manager
  • Supreme Touch Home Health Services Corp
  • Columbus, OH
  • Job Description Job Description RN Clinical Supervisor Job Description CLINICAL SUPERVISOR The Clinical Supervisor is a ...
  • 10/29/2024 12:00:00 AM

Income Estimation for Staff Nurse - RN, Sr. - Medical Management jobs
$91,344 to $114,134