Job Summary

A health insurance company is searching for a person to fill their position for a Remote Medical Management Nurse in Falls Church.

Core Responsibilities of this position include:

• Conducting 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
• Consulting with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process
• Collaborating with providers to assess member’s needs for early identification of and proactive planning for discharge planning

Qualifications Include:

• Current active unrestricted RN license to practice as a health professional in applicable state(s) or territory of the United States
• Minimum of 3 years acute care clinical experience or case management, utilization management or managed care experience; or any combination of education and experience
• Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills