Nurse Medical Management
Where
- Indianapolis, IN
What you'll be doing
- Responsible for collaborating with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources. Applies clinical knowledge to work with facilities and providers for care coordination. Works with medical directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied.
What your background should be
- Requires 2 years of acute care clinical experience. Current unrestricted RN license in state of residence.
Required Schooling / Training
- AS/BS in nursing preferred
Who is the client company
- Concern about managed health care services.
- If you are interested in this position, send your resume to apply@kochdavis.com
