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Nurse Medical Management Specialist
2 months ago
At Absolute Staffing & Consulting Solutions, we are seeking a highly skilled Nurse Medical Management professional to join our team.
Job Summary:The Nurse Medical Management role is responsible for collaborating with healthcare providers and members to promote quality member outcomes, optimize member benefits, and promote effective use of resources for complex medical issues.
Key Responsibilities:- Conducts precertification, 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.
- Consults with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process.
- Collaborates with providers to assess member's needs for early identification of and proactive planning for discharge planning.
- Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required.
- Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.
- Serves as a resource to lower-leveled nurses and may participate in or lead intradepartmental teams, projects and initiatives.
- Current active unrestricted RN license to practice as a health professional in applicable state(s) or territory of the United States.
- Requires minimum of 3 years acute care clinical experience or case management, utilization management or managed care experience; or any combination of education and experience, which would provide an equivalent background.
- Participation in the American Association of Managed Care Nurses preferred.
- Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred.
- Prior managed care experience strongly preferred.
At Absolute Staffing & Consulting Solutions, we offer a dynamic and supportive work environment, competitive compensation, and opportunities for professional growth and development.
We are an equal opportunity employer and welcome applications from diverse candidates.
Please submit your application, including your resume and cover letter, to [insert contact information].
