Medicare Advantage RN Review Analyst

Strategic Staffing Solutions; Michigan; Remote; USD 70,000 - 85,000; Full time

Job summary

A leading healthcare provider is seeking a Mid-Senior level Clinical Operations Specialist for a remote contract role in Michigan. The successful candidate will be responsible for claims approval, operational activities, and system maintenance. Ideal candidates will have clinical experience and a nursing degree. This is a great opportunity for those looking to advance their career in healthcare.

Qualifications

• Two to four years of clinical experience.
• Demonstrated clinical knowledge related to patient care.

Responsibilities

• Assist in deployment and maintenance of clinical operational processes.
• Identify business problems and prepare reports.
• Design and maintain assigned systems.

Skills

Clinical Knowledge

Problem Solving

Education

Associate's Degree in Nursing

Bachelor's Degree

Job description

Job Description

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Location: Detroit, MI (Remote - must be local to Michigan)

Duration: 12+ Months

Role Type: W2 Contract Engagement

Summary

Responsible for the approval or rejection of claims and/or benefit interpretation. May be required to enter or reference data via PC and/or Clinical Review Team terminal. Advise customers of updates across all lines of business, highlighting benefits to members and impacts on group experience and utilization.

Essential Duties and Responsibilities

• Assist in deployment, operational activities, and/or development, implementation, and maintenance of clinical operational processes.
• Identify and analyze business problems; devise procedures for solutions; prepare reports and document results.
• Design, develop, modify, test, implement, and maintain assigned systems, independently or as part of a team.
• Troubleshoot problems and submit recommendations; interface with other areas to resolve issues.
• Assist personnel by answering questions, providing information, and training.

Education and Experience

• Associate's degree in nursing or RN Diploma required; Bachelor's Degree preferred.
• Two to four years of clinical experience.
• Demonstrated clinical knowledge related to patient care and healthcare delivery processes.

Certificates, Licenses, and Registrations

• Current unrestricted Michigan registered nurse license required.

Additional Details

Seniority Level: Mid-Senior level

Employment Type: Contract

Job Function: Health Care Provider

Industries: Hospitals and Healthcare

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