Medical Administrative Nurse
Core
Provides clinical support and expert guidance to Medical Directors and Physicians to ensure effective evaluation and review of medical services within the Medicaid division.
Role type
Senior IC medical administrative nurse (utilization review & policy)
Builds
Medical guidelines, criteria, and reports for Medicaid service reviews
Domain
US Healthcare / Medicaid Administration
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Medical guidelines knowledge, program administration, healthcare policy, analytical skills, medical coding, billing and claims resolution, data collection and reporting
Preferred skills
Case management, healthcare quality improvement, project management, healthcare informatics, OSHA regulations
Technologies
None explicitly stated
Responsibilities
Research and gather data for review of specific medical services, develop and maintain medical criteria and guidelines, act as a liaison between providers and Medical Directors, review current medical journals for new therapies, assist with provider requests regarding policy or coverage issues
Seniority
Mid-level, hands-on IC