Registered Nurse-Review Analyst

Iconma Portal; États-Unis; À distance; USD 65 000 - 95 000; Plein temps

Avantages offerts par ce poste

Health benefits

Referral program

Excellent growth opportunities

Résumé du poste

Health Insurance Client is seeking a Registered Nurse-Review Analyst for a remote position. The role focuses on medical necessity review across inpatient, outpatient, and ambulatory services, ensuring appropriate level of care and coordination of care plans where needed.

Candidates should have a nursing degree, an active Michigan RN license, and 2–4 years of clinical experience with potential preference for case management certification in a managed care setting.

Qualifications

• Two to four years of clinical experience in health care (acute care, discharge planning, case management, utilization review).
• RN license with current unrestricted Michigan license required.
• Certification in Case Management may be preferred depending on department.

Responsabilités

• Perform prospective, concurrent, and retrospective review of inpatient, outpatient, ambulatory and ancillary services to ensure medical necessity and appropriate level of care.
• May establish care plans and coordinate care through the health care continuum including member outreach assessments.

Connaissances

Clinical experience

Care coordination

Utilization review

Case management

Formation

Bachelor’s degree in nursing or related field

RN license (Michigan)

MA Inpatient Precertifi (precertification)

Outils

Certification in Case Management

Description du poste

Our client, a Health Insurance company, is looking for a Registered Nurse-Review Analyst for their Remote location.

Responsibilities:

• Perform prospective, concurrent, and retrospective review of inpatient, outpatient, ambulatory and ancillary 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.

Requirements:

• MA Inpatient Precertifi
• Bachelor’s degree in nursing, allied health, business, or related field preferred.
• 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 related to patient care and health care delivery processes.
• One (1) year of health insurance plan experience or managed care environment preferred.
• Registered Nurse with current unrestricted Michigan Registered Nurse license required.
• Certification in Case Management may be preferred based upon designated department assignment.

Why Should You Apply?

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities