Responsible for the review of precertification admission and concurrent reviews for the appropriateness of the inpatient setting utilizing InterQual criteria.
Required to enter or reference data via PC, collaborate with facilities, providers and Medical Directors. Must have excellent written and oral communication skills.
Other related skills may be required to perform this job. 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. One (1) year health insurance plan experience or managed care environment preferred.
Registered Nurse with current unrestricted Michigan Registered Nurse license required.
Requirements :
- Registered Nurse with current Michigan driver's license.
- Associate Degree or nursing diploma required.
- Two (2) years patient care experience.
- Triage, case management or utilization review experience.
- Expertise in the use of medical terminology.
- InterQual knowledge preferred.
- Some weekends and corporate holidays.
Top 3 Required Skills / Experience -
- 2 years acute care experience with an unrestricted Registered Nurse license
- ICU / ER preferred or for post-acute care positions SNF / Rehab / LTACH) *should not just be 2 years in a specialized field such as NICU / OB / BH / Substance Abuse
- InterQual / MCG or other utilization review experience
Required Skills / Experience - The rest of the required skills / experience. Include :
- Advanced computer skills
- 40+ WPM typing
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