Medical Management Nurse – Weekends

This is a fully remote position, open to applicants in Florida.

📋 Description

• Review intricate and demanding cases that necessitate nursing judgment, critical thinking, and a comprehensive assessment.

• Evaluate the medical necessity of requested services.

• Collaborate with healthcare professionals to comprehend and assess members’ clinical situations.

• Provide consultation to the Medical Director regarding ambiguous or complex cases.

• Act as a resource for clinicians and junior nurses.

• Analyze clinical information of members and utilize clinical guidelines and policies to assess medical necessity.

• Advocate for quality outcomes for members, optimize their benefits, and promote efficient resource utilization.

• Assess complex clinical concepts, symptoms, and aggregate member data.

• Identify inappropriate types, levels, or quality of care.

• Suggest alternative types, locations, or levels of suitable care.

• Work in conjunction with case management nurses on discharge planning.

• Ensure that patients receive the necessary equipment, environment, and education for a safe discharge.

• Participate in interdepartmental and cross-functional teams, projects, initiatives, and process improvement efforts.

• Educate members on plan benefits and physicians, and assist with case management.

• Collaborate with leadership to improve training and orientation materials.

• Conduct quality audits and assist with corrective action plans.

• Support leadership and stakeholders in process improvement initiatives.

• Aid in the training of junior clinician staff.

⛳️ Requirements

• A minimum of an associate’s degree in nursing.

• At least 4 years of experience in care management or case management.

• A minimum of 2 years of clinical, utilization review, or managed care experience.

• An equivalent combination of education and experience may be accepted.

• A current, active, valid, and unrestricted RN license and/or certification to practice as a health professional within the scope of licensure in applicable states or territories of the United States.

• Multi-state licensure is required if services are provided in multiple states.

• Candidates must reside in the state of Florida.

• Availability to work 4/10s Saturday-Tuesday, from 7AM to 6PM EST.

• Must be available for 3 holidays per year.

• COVID-19 and Influenza vaccinations are mandatory for certain patient/member-facing roles, unless an acceptable exemption is provided.

• Must be able to attend required in-person training sessions.

• Should be within a reasonable commuting distance from the posting location(s), unless a legal accommodation is granted.

🏝️ Benefits

• Merit increases.

• Paid holidays.

• Paid Time Off.

• Incentive bonus programs.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• Short-term disability benefits.

• Long-term disability benefits.

• 401(k) match.

• Stock purchase plan.

• Life insurance.

• Wellness programs.

• Financial education resources.

• Opportunity for virtual full-time work, except for mandatory in-person training sessions.

• Emphasis on work-life integration and flexibility.

• Opportunities for training and orientation.