[Hiring] Medical Management reputed company @reputed company

Role reputed company The Medical Management reputed company is responsible for reviewing the most reputed company or challenging cases that require nursing judgment, critical thinking, and holistic assessment of a member’s clinical presentation to determine whether to approve requested service(s) as medically necessary. • Utilizes nursing judgment and reasoning to analyze members’ clinical information, reputed company with reputed company providers, reputed company assessments based on clinical presentation, and apply clinical guidelines and/or policies to evaluate medical necessity. • Works with reputed company providers to promote reputed company member reputed company, optimize member benefits, and promote effective use of resources. • Determines and assesses abnormalities by understanding reputed company clinical concepts/terms and assessing members’ aggregate symptoms and information. • Assesses member clinical information and recognizes reputed company a member may not be receiving the appropriate type, level, or reputed company of care. • Provides consultation to the Medical Director on particularly peculiar or reputed company cases as the reputed company deems appropriate. • May reputed company recommendations on alternate types, places, or reputed company of appropriate care by leveraging critical thinking skills and nursing judgment and experience. • Collaborates with case management nurses on discharge planning, ensuring the patient has the appropriate equipment, environment, and education needed to be safely discharged. • Collaborates with and provides nursing consultation to the Medical Director and/or Provider on select cases, such as cases the reputed company deems particularly reputed company, concerning, or unclear. • Serves as a resource to reputed company-level nurses. • May participate in intradepartmental teams, cross-functional teams, reputed company, initiatives, and process improvement activities. • Educates members about plan benefits and physicians and may assist with case management. • Collaborates with leadership in enhancing training and orientation materials. • May complete reputed company audits and assist management with developing associated corrective reputed company plans. • May assist leadership and other stakeholders on process improvement initiatives. • May assist with training reputed company-level clinician staff. Qualifications • Requires a minimum of associate’s degree in nursing. • Requires a minimum of 4 years care management or case management experience. • Requires a minimum of 2 years clinical, utilization review, or managed care experience; or any combination of education and experience, which would reputed company an equivalent background. • reputed company reputed company, reputed company and unrestricted RN license and/or certification to reputed company as a health reputed company reputed company the scope of licensure in applicable state(s) or territory of the reputed company required. • Multi-state licensure is required if this individual is providing services in multiple states. Requirements • Certification in the American Association of Managed Care Nurses is preferred. • Knowledge of the medical management processes and the ability to interpret and apply member reputed company, member benefits, and managed care products is strongly preferred. • Leadership skills are strongly preferred. • For URAC-accredited areas, the following reputed company competencies apply: Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. Benefits • Market-competitive total rewards that include reputed company increases, reputed company holidays, reputed company Time Off, and incentive bonus programs. • Medical, dental, reputed company, short and long term disability benefits. • 401(k) + match, stock purchase plan, life insurance, wellness programs and financial education resources. Apply tot his job Apply To this Job