5 Registered Nurse-Review Analys Jobs in Detroit, MI
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Registered Nurse-Review Analys
$78k-96k (estimate)
Full Time | Business Services
3 Days Ago
TekWissen ® is Hiring a Registered Nurse-Review Analys Near Detroit, MI
OverviewTekWissen 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: 12 Months Job Type: Contract Work Type: Remote Dept: UM Program Mgmt Description
Title: Registered Nurse-Review Analys Work Location: Detroit, MI, 48243 Duration: 12 Months Job Type: Contract Work Type: Remote Dept: UM Program Mgmt Description
- Use established medical policy and guidelines to perform prospective, concurrent, and retrospective medical necessity review of post-acute care services to ensure medical necessity for appropriate setting, appropriate length of stay, including appeal requests initiated by providers, facilities and members.
- Will coordinate care through the health care continuum including member outreach.
- Provides support and alternative care support for member not appropriate for post-acute care service as well formulate discharge readiness for members transitioning from a post-acute care setting to a lower level of care.
- Bachelor’s degree in nursing, allied health, business, or related field preferred.
- Two (2) to four (4) years of clinical experience which may include post-acute care, home care, acute patient care, discharge planning, case management, and utilization review, and caring for aging population in the home or post-acute care setting, 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.
- The following skills are not required, but may be preferred depending on assignment:
- Understanding Medicare Requirements for skilled vs non-skilled services in post-acute care and home setting
- Certification in Case Management
- Experience with management of patients with compromised airways requiring skilled services
- Experience with goals planning and intervention for patients recovering after unplanned or prolonged hospital admission including but not limited to stroke, hip and femur fractures with surgical intervention after a fall, sepsis, ventilator dependency, sever change in functional ability.
Job Summary
JOB TYPE
Full Time
INDUSTRY
Business Services
SALARY
$78k-96k (estimate)
POST DATE
06/24/2024
EXPIRATION DATE
07/18/2024
WEBSITE
tekwissen.com
HEADQUARTERS
ANN ARBOR, MI
SIZE
200 - 500
FOUNDED
1998
TYPE
Private
CEO
STEVE MOMORELLA
REVENUE
$10M - $50M
INDUSTRY
Business Services
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About TekWissen ®
TekWissen provides enterprise software, web development, data warehousing, systems integration, information technology security services.
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