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Registered Nurse-Review Analys

1 month ago

Detroit, United States Tekwissen Full time
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: 12 Months

Job Type: Contract

Work Type: Onsite Training and later 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.

TekWissen® Group is an equal opportunity employer supporting workforce diversity.