Optima Health - Virginia Beach, VA

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The Case Manager-Research staff reviews requests for payment of medical services in the authorization process. The case manager will review for payment purposes requests for non-covered services; out of network services and new technology in clinical practice. The staff works independently but under the direction of the Medical Directors of the Plan for non-payment determinations.

Graduate of an accredited school of professional nursing (RN) required. Minimum of 3 years experience as a RN in a physician office, acute hospital setting, managed care or clinic setting required.

Current RN license from the Commonwealth of Virginia Board of Nursing required. One of the following certifications (ACM, CCM, CMCC) is required upon hire. If not certified at the time of hire it is required that the certification will be obtained within one (1) year of eligibility.

Basic knowledge of Microsoft Office applications is required. A bility to send an email and research the internet is required.

Optima Health - 19 months ago - save job - block
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