Job Summary
A health insurance company has an open position for a Remote Nurse Medical Management I or II in Arlington.
Core Responsibilities Include:
- Conducting precertification, continued stay review, care coordination, or discharge planning for appropriateness of treatment
- Consulting with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care
- Collaborating with providers to assess member’s needs for early identification of and proactive planning for discharge planning
Applicants must meet the following qualifications:
- Requires current active unrestricted RN license to practice as a health professional in applicable state or territory of the United States
- AND 3-5 years acute care clinical experience or case management, utilization management or managed care experience
- Participation in the American Association of Managed Care Nurses preferred
- Must have knowledge of medical management process & ability to interpret & apply member contracts, member benefits, etc
