RN Review Analyst

KYYBA Inc; Detroit (MI); On-site; USD 60,000 - 90,000; Full time

Job summary

An established industry player is seeking a skilled Registered Nurse to join their team as a Medical Policy Specialist. This role involves reviewing and maintaining medical policies to ensure they are evidence-based and compliant with regulations. The ideal candidate will have a strong background in medical terminology, coding, and health insurance, particularly with Medicare Advantage. Join a vibrant work culture that values empowerment and offers career development opportunities. This position provides a chance to make a significant impact on patient care and policy development in a supportive environment.

Benefits

Medical, dental, vision insurance

401(k) plan

Term life insurance

Voluntary life and disability insurance

Optional Pre-paid legal and Identity theft plans

Optional Medical and Dependent FSA

Work visa sponsorship

Opportunities for advancement

Long-term assignment with potential for hire by the client

Qualifications

• Expertise in developing and analyzing medical policies.
• Strong foundation in medical terminology and CMS regulations.

Responsibilities

• Review and maintain medical policies to ensure compliance.
• Respond to internal stakeholder inquiries regarding medical policy.

Skills

Policy development and analysis

Medical knowledge

Health Insurance experience

Strong writing and communication skills

Research and analytical skills

Attention to detail

Education

Bachelor's degree in Nursing

Master’s degree in Nursing or related field

Tools

Microsoft Office

Document management systems

Job description

Job Title: RN Review Analyst

About Kyyba:

Founded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances.

At Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values: value, passion, excellence, empowerment, and happiness, creating a vibrant and productive atmosphere. We empower our employees with resources, incentives, and flexibility to support a healthy, balanced, and fulfilling career, offering valuable benefits and a balanced compensation structure along with career development opportunities.

Job Description

Engagement Description - We are seeking a highly skilled and experienced Registered Nurse (RN) to join our team as a Medical Policy Specialist. In this role, you will review and maintain medical policies and procedures to ensure they are evidence-based, aligned with professional guidelines, and compliant with CMS regulations. Your expertise will support our organization's mission and commitment to high-quality patient care. You will also respond to internal stakeholder questions regarding medical policy and coding matters.

Top 3 Required Skills/Experience

1. Policy development and analysis experience: Ability to develop, analyze, and interpret medical policies, identify areas for improvement, and update policies accordingly.
2. Medical knowledge and background: Strong foundation in medical terminology, coding, billing, CMS Medicare regulations, and clinical practices.
3. Health Insurance experience: Experience with Medicare Advantage in a health insurance setting; Utilization Management experience is a plus.

Additional Skills/Experience

• Strong writing and communication skills: Ability to produce clear, concise, and accurate policies and communicate complex medical concepts effectively.
• Research and analytical skills: Capable of conducting research, analyzing data, and staying current with industry trends and best practices.
• Attention to detail and organizational skills: Ability to manage multiple projects, maintain accurate records, and ensure version control.

Preferred Skills/Experience

• Technical Skills: Proficiency in Microsoft Office, especially Word, and experience with content or document management systems.
• Stakeholder Management: Ability to collaborate effectively with healthcare professionals, administrators, and subject matter experts.
• Document Preparation: Skilled in formatting documents according to industry standards and revising drafts for accuracy and clarity.

Education/Certifications

• Bachelor's degree in Nursing (minimum); Master’s degree in Nursing or related field preferred.
• Current RN Licensure.

Location

Detroit, MI

Disclaimer

Kyyba is an Equal Opportunity Employer. We do not discriminate based on race, religion, color, sex, gender identity, sexual orientation, age, disability, veteran status, or any other protected class. Minorities, females, protected veterans, and individuals with disabilities are encouraged to apply. Employment decisions are based on qualifications, merit, and business needs. We provide reasonable accommodations for applicants and employees with disabilities upon request.

Rewards

• Medical, dental, vision insurance
• 401(k) plan
• Term life insurance
• Voluntary life and disability insurance
• Optional Pre-paid legal and Identity theft plans
• Optional Medical and Dependent FSA
• Work visa sponsorship
• Opportunities for advancement
• Long-term assignment with potential for hire by the client

Additional Recognition

• INC 5000 company for 10 years
• Michigan Economic Bright Spots
• Crain’s Detroit Business Top Staffing Service Companies
• TechServe Alliance Excellence Award
• Best of MichBusiness in HR Wizards & Partnerships
• Metro Detroit Elite in Recruitment, Selection & Orientation
• 101 Best & Brightest Companies to Work for in Michigan