Job Summary

A healthcare company has an open position for a Remote Nurse Medical Management Senior.

Core Responsibilities Include:

• Care coordination and discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts
• Ensure member access to medically necessary quality healthcare in a cost effective setting according to member contract
• Consults with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, care throughout the medical management process

Skills and Requirements Include:

• Current, active, unrestricted RN license to practice as a health professional within the scope of practice in applicable state(s)
• Eligible to obtain a license in NV and CO
• Minimum 2 - 3 years acute care clinical experience is required. (3 – 5 years for the Level ll and Sr roles required)