Job Summary
An insurance company needs applicants for an opening for a Telecommute Medical Management II Registered Nurse.
Core Responsibilities Include:
- Conducting pre-certification, inpatient, retrospective, out of network and appropriateness of treatment setting reviews
- Applying clinical knowledge to work with facilities and providers for care coordinatio
- Ensuring medically appropriate, high quality, cost effective care
Qualifications for this position include:
- Ability to interpret and apply member contracts, member benefits, and managed care products
- AS/BS in nursing
- 3-5 years acute care clinical experience; or any combination of education and experience
- Current unrestricted RN license in the State of Virginia required
- Must have knowledge of medical management process
