Medical Management Nurse

6 days ago


Remote, Oregon, United States Enterprise Engineering Full time
About the Role

We are seeking an experienced Nurse to join our team as a Medical Management Nurse with Enterprise Engineering.

This role offers a unique opportunity to apply your clinical expertise in a fast-paced environment, driving quality healthcare outcomes for our members.

You will be responsible for conducting medical necessity reviews, collaborating with the Medical Director, and ensuring timely discharge planning.

Key Responsibilities:
  • Review patient records, applying clinical criteria to determine the need for care.
  • Collaborate with the Medical Director to ensure high-quality adverse determination notices.
  • Communicate effectively with transition of care teams to promote smooth patient transfers.
  • Meet productivity targets while maintaining accurate records.
  • Provide guidance and support to non-clinical team members as needed.
Requirements:
  • A minimum of 2 years' experience in medical management clinical functions.
  • An Associate's degree in Nursing, preferred.
  • A working knowledge of MCG, InterQual, and NCQA standards.

Estimated Salary: $85,000 - $105,000 per annum.



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