Location: Nationwide
Compensation: To Be Discussed
Staff Reviewed: Tue, Mar 14, 2023
This job expires in: 24 days
Job Summary
A health services company is filling a position for a Remote Medical Management Registered Nurse II.
Core Responsibilities Include:
- Being responsible for maintaining unit service level goals
- Identifying and referring Members with Potential Quality of Care issues to Quality Management
- Complying with CMS, NCQA, ERISA and PA. Act 68, and other state and federal regulations
Skills and Requirements Include:
- A minimum of 5 years clinical experience working in an acute care hospital setting
- Preferably 2 years of managed care/preauthorization experience
- Must be currently licensed as an RN in the Commonwealth of Pennsylvania
- Knowledge of Act 68, NCQA, ERISA and CMS regulations
- Knowledge of ICD-9-CM, CPT and HCPCS coding
- Knowledge of managed care principles and emerging health treatment modalities
