Registered Nurse-Review Analys

TekWissen ®; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

An innovative health insurance company is seeking a dedicated Registered Nurse-Review Analyst to join their remote team. This exciting role involves performing comprehensive reviews of post-acute care services to ensure medical necessity and appropriate care levels. You will have the opportunity to establish care plans and coordinate care, making a significant impact on patient outcomes. With a focus on collaboration and excellence, this position offers a chance to work in a dynamic environment where your clinical expertise will be valued. If you're passionate about healthcare and looking to make a difference, this opportunity is perfect for you.

Qualifications

• Registered Nurse with current unrestricted Michigan license required.
• 2-4 years of clinical experience in patient care and utilization review.

Responsibilities

• Review post-acute care services for medical necessity and appropriate care.
• Establish care plans and coordinate care through member outreach.

Skills

Computer Skills

Clinical Experience in SNF, LTAC or IPR

Utilization Management Experience

Education

Bachelor’s Degree in Nursing or Related Field

Current Michigan Registered Nurse License

Tools

Microsoft Office

Job description

Overview

TekWissen is a global workforce management provider headquartered in Ann Arbor, Michigan that offers strategic talent solutions to our clients world-wide. Our client is a health insurance company that offers various types of health care coverage plans including individual and family, dental and vision, and plans for employers.

Title: Registered Nurse-Review Analyst
Work Location: Detroit, MI, 48243
Duration: 10 Months
Job Type: Contract
Work Type: Remote
Dept: MA Post-Acute Care UM E

Engagement Description

• Perform prospective, concurrent and retrospective review of post-acute care services to ensure medical necessity, appropriate length of stay, intensity of service and level of care, including appeal requests initiated by providers, facilities and members.
• May establish care plans and coordinate care through the health care continuum including member outreach assessments.

Top 3 Required Skills/Experience

• Above average computer skills (Microsoft Office).
• Clinical experience in SNF, LTAC or IPR preferred.
• Prefer utilization management experience.

Required Skills

• Registered Nurse with current unrestricted Michigan Registered Nurse license required.
• Two (2) to four (4) years of clinical experience which may include acute patient care, discharge planning, case management, and utilization review, etc.
• Demonstrated clinical knowledge and experience relative to patient care and health care delivery processes.

Preferred Skills

• Bachelor’s degree in nursing, allied health, business, or related field preferred.
• One (1) year health insurance plan experience or managed care environment preferred.

Education/Certifications

• Current unrestricted Michigan Registered Nurse license required.

TekWissen Group is an equal opportunity employer supporting workforce diversity.

Seniority level: Entry level

Employment type: Full-time

Job function: Health Care Provider

Industries: IT Services and IT Consulting