Nurse Medical Management Ii
Current• Work closely with medical directors to ensure medical appropriateness of care through the determination of medical necessity of inpatient admissions by initial, continued stay and reconsiderations reviews.• Apply clinical knowledge to conduct precertification, initial, continued stay review, care coordination, and discharge planning for appropriateness of treatment• Guarantee state and regulatory compliance with required criteria, medical policy, member eligibility, and contractual obligations• Efficiently manage high-volume facility while maintaining a positive working relationship• Significantly exceed departmental productivity goals while ensuring strong compliance with organizational audits and state regulatory requirements• Build positive relationships with coworkers and actively contribute to the accomplishment of team goals guaranteeing all necessary tasks are completed within required timeframes• Collaborate with providers and facility nurses to certify accurate and relevant information is used to enable member access to appropriate medical care• Identify member needs for potential discharge planning obstacles requiring interdisciplinary action for the best possible outcomes
