Overview :
TekWissen Group is a workforce management provider throughout the USA and many other countries in the world. 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 Analys
Work Location : Detroit, MI, 48243
Duration : 9+ Months
Job Type : Contract
Work Type : Remote
Dept : MA Inpatient Precertifi
Job Description :
- 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.
- 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 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.
- Certification in Case Management may be preferred based upon designated department assignment.
- Requested criteria : Above average computer skills (Microsoft office).
- Clinical experience in ICU, ER, or medical surgical unit preferred.
- Prefer utilization management experience.
- Resource will be able to perform this role offsite.
- May be required to come into the office for meetings and training.
TekWissen® Group is an equal opportunity employer supporting workforce diversity.
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