Medical Management RN

Location: Cincinnati, OH
Date Posted: 11-26-2018
 Medical Management RN – Health Plan
Cincinnati, OH
*** This Full Time, Benefits Available, CONTRACT position is expected to last 4-6 months, or longer! ***
Medical Management RN Job Summary: 
  • As a member of the medical management team, the Case Management & Utilization Management RN plays an integral part in the coordination of care assessing the member’s condition and providing them the necessary resources, options, and coordination for a healthy care outcome. 
  • They are primarily responsible for the care management planning and utilization review (concurrent or retrospective) of the member’s care.  
  • The Nurse coordinates and monitors the care of Health Plan members and develops a nursing plan of care. 
  • Ensures appropriate level of care through comprehensive concurrent review for medical necessity of outpatient and inpatient care, as well as the utilization of ancillary services, following evaluation of medical guidelines and benefit determination.
  • The Nurse acts as an advocate for members and their families linking them to other members of the care team to help them gain knowledge of their disease process and to identify community resources for continued growth toward a maximum level of independence. 
 Medical Management RN Background Profile: 
  • Current unrestricted state Registered Nurse (R.N.) license.
  • Bachelors of Science in Nursing (BSN) or related field is a plus.
  • Roughly 3-4 years acute care clinical nursing experience; higher acuity settings (ER, CCU, ICU, OR, etc) preferred.
  • Around 3-5 years of case management and/or utilization review experience
  • At least 1-3 years with a managed care organization (Health Plan/ HMO/IPA/Medical Group/TPA/MSO, etc).
  • Participation in the American Association of Managed Care Nurses preferred.
  • Knowledge of guidelines for Medicaid/Medicare and related state programs is required.
  • Knowledge of InterQual criteria and other guidelines for medical necessity, setting and level of care, and concurrent patient management.
  • Strong computer skills to include Microsoft Word, Excel, database use, and basic data entry.
  • Strong oral and written communication skills; ability to interact within all levels of the organization as well as with external contacts.
  • Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously.

480.425.2451 (CALL – TEXT – FAX)
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