Registered Nurse

2 months ago

Detroit, United States PSG Global Solutions Careers Full time

Apply now and our proprietary system will quickly have you in front of a live recruiter.
The Opportunity
Description
We're looking for a RN - Review Analyst, working in Insurance industry in Detroit, Michigan, United States.

  • 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.
  • Coordinate care through the health care continuum including member outreach.
  • Provide 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.

Our Client

Our client is a fast-growing industry-recognized staffing firm. Recruiting critical IT, Financial, Engineering, Healthcare, and Data Analytics talent. With 20+ years' experience and growth.

Connections in Automotive, Healthcare, Retail, Financial & Insurance, and Professional & Business Services. Working to bring top talent together with premier organizations.

Big enough to have great opportunities. Small enough to care about finding the right one for you.

It'sabout relationships based on mutual interest. The results are low turnover, long-lasting partnerships and growth. Want to work for a company invested in your success?

Experience Required for Your Success
  • Bachelor's degree in nursing, allied health, business, or related field preferred
  • 2-4 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.
  • 1 year health insurance plan experience or managed care environment preferred
  • Demonstrated clinical knowledge and experience relative to patient care and health care delivery processes
  • 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

What Do You Think?
Does your experience reflect what it takes to be successful in this role? Do the work and challenges get you excited about what's possible?

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