Medical Drug Management Nurse
Company: VirtualVocations
Location: Fairfax
Posted on: November 14, 2024
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Job Description:
A company is looking for a Medical Drug Management Nurse
Reviewer.
Key Responsibilities
Determine the appropriateness of services and manage reviews of
cases, including appeals
Evaluate and direct members to appropriate healthcare services and
ensure continuity of care
Provide educational assistance to providers regarding covered and
non-covered care
Required Qualifications, Training, and Education
Graduate of a registered nursing program approved by the Ohio State
Nursing Board
3 years of experience as a Registered Nurse with clinical and
utilization/case management experience
Current unrestricted Registered Nurse license in the State of
Ohio
Knowledge of medical/pharmacy terminology and managed care
processes
Strong knowledge of clinical claim management including ICD 10,
CPT, and HCPCS codes
Keywords: VirtualVocations, Silver Spring , Medical Drug Management Nurse, Executive , Fairfax, Maryland
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