Nurse Medical Mgmt I

Responsible for collaborating with healthcare providers and or members to promote quality member outcomes, optimize member benefits, and promote effective use of resources for complex medical issues. Ensures medically appropriate, high quality, cost effective care through assessing medical necessity and utilizing medical policy and clinical guidelines.

Requirements

• BSN degree
• Current active unrestricted RN license to practice as a health professional in applicable state(s) of the United States
• 3-5 years acute care clinical experience or case management, utilization management or managed care experience
• Healthcare related certification and or Master’s degree preferred
• Participation in the American Association of Managed Care Nurses preferred