Utilization Review Nurse

3 days ago


Michigan, United States Hirextra -World's First Staffing Aggregator Full time

Description:

  • Perform prospective, concurrent and retrospective review of post-acute care 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.

Top 3 Required Skills/Experience –

  • Above average computer skills (Microsoft office).
  • Clinical experience in SNF, LTAC or IPR preferred.
  • Prefer utilization management experience.

Required Skills/Experience – The rest of the required skills/experience. Include:

  • Registered Nurse with current unrestricted Michigan Registered Nurse license required.
  • 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.

Preferred Skills/Experience – Optional but preferred skills/experience. Include:

  • Bachelor’s degree in nursing, allied health, business, or related field preferred.
  • One (1) year health insurance plan experience or managed care environment preferred.

Education/Certifications – Include:

  • Current unrestricted Michigan Registered Nurse license required.

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