Registered Nurse-Review Analys

TekWissen ®; United States; Remote; USD 60,000 - 90,000; Full time

Job summary

Join a forward-thinking health insurance company as a Registered Nurse-Review Analyst, where you will play a vital role in ensuring quality care for members. In this remote position, you will conduct reviews of post-acute care services, ensuring they meet medical necessity and appropriate standards. Your clinical expertise will guide care plans and member outreach, making a significant impact in the health care continuum. This role is perfect for those with a passion for patient care and a desire to work in a dynamic environment that values diversity and innovation.

Qualifications

• Registered Nurse with 2-4 years clinical experience required.
• Knowledge of patient care and health care delivery processes.

Responsibilities

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

Skills

Clinical experience in SNF, LTAC or IPR

Utilization management

Above average computer skills (Microsoft Office)

Education

Bachelor’s degree in nursing, allied health, business, or related field

Current unrestricted Michigan Registered Nurse license

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. It offers different types of health care coverage plans that include individual and family, dental and vision, plans for employers, etc.

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

Job 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/Experience

• 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.
• Demonstrated clinical knowledge and experience relative to patient care and health care delivery processes.

Preferred Skills/Experience

• 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.

TekWissen is an emerging global human capital, recruitment and IT services organization. Operating since 2009, we draw upon more than a decade of staffing experience to deliver critical talent acquisition solutions and IT engagements for our clients.

Our global footprint covers six countries: United States, Canada, Australia, India, United Kingdom and the Philippines.

Seniority level

• Entry level

Employment type

• Full-time

Job function

• Health Care Provider
• Industries: IT Services and IT Consulting