Job Summary

A health insurance company has an open position for a Remote Nurse Medical Management I II Sr.

Candidates will be responsible for the following:

• Conduct pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment
• Ensure member access to medical necessary, quality healthcare in a cost effective setting according to contract
• Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care

Qualifications Include:

• Requires current active unrestricted RN license to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States
• AND 2 years acute care clinical experience
• Requires strong oral, written and interpersonal communication skills
• Requires problem-solving skills, facilitation skills, and analytical skills
• Must have high speed internet connection
• Must be self-motivated, professional, organized, with attention to detail