Clinical Review Specialist
2 days ago
We are seeking a highly skilled Clinical Review Specialist to join our team at LanceSoft. As a key member of our post-acute care review team, you will be responsible for ensuring the medical necessity of services provided to our members.
Key Responsibilities:
- Conduct prospective, concurrent, and retrospective medical necessity reviews of post-acute care services
- Use established medical policy and guidelines, including InterQual and MCG, to inform review decisions
- Coordinate care through the healthcare continuum, including member outreach and support
- Develop and implement discharge readiness plans for members transitioning from post-acute care to lower levels of care
Requirements:
- Bachelor's degree in nursing, allied health, business, or related field
- Two to four years of clinical experience, including post-acute care, home care, acute patient care, discharge planning, case management, and utilization review
- Demonstrated clinical knowledge and experience relative to patient care and healthcare delivery processes
- One year health insurance plan experience or managed care environment preferred
- Registered Nurse with current unrestricted Michigan Registered Nurse license required
LanceSoft is an equal opportunity employer and prohibits discrimination and harassment of any kind. We are committed to creating a diverse and inclusive work environment that values and respects all employees.
-
Clinical Review Specialist
3 days ago
Detroit, Michigan, United States W3R Consulting Full timeJob Title - Registered Nurse - Clinical ReviewDuration - 10 monthsLocation - RemotePay: $40.00/hr on W2We are seeking a highly skilled Registered Nurse to join our team as a Clinical Review Specialist. In this role, you will be responsible for performing prospective, concurrent, and retrospective reviews of inpatient, outpatient, ambulatory, and ancillary...
-
Clinical Review Specialist
8 hours ago
Detroit, Michigan, United States LanceSoft Full timeJob SummaryWe are seeking a skilled Clinical Review Specialist to join our team at LanceSoft. In this role, you will be responsible for conducting thorough reviews of inpatient, outpatient, and ambulatory services to ensure medical necessity and appropriate care.Key Responsibilities:Perform prospective, concurrent, and retrospective reviews of healthcare...
-
Clinical Review Specialist
2 weeks ago
Detroit, Michigan, United States ICONMA Full timeJob Title: Registered Nurse-Review AnalysLocation: Detroit, MIDuration: 10-11 monthsDescription:Job Summary:We are seeking a highly skilled Registered Nurse to join our team as a Clinical Review Specialist. In this role, you will be responsible for performing prospective, concurrent, and retrospective reviews of inpatient, outpatient, ambulatory, and...
-
Clinical Review Specialist
2 weeks ago
Detroit, Michigan, United States LanceSoft Full timeJob Title: Registered Nurse-Review AnalystJob Summary:We are seeking a highly skilled Registered Nurse to join our team as a Review Analyst. In this role, you will be responsible for conducting medical necessity reviews of post-acute care services to ensure compliance with established medical policy and guidelines.Key Responsibilities:Conduct prospective,...
-
Clinical Review Specialist
1 month ago
Detroit, Michigan, United States R1 RCM Full timePhysician Advisor Role at R1 RCMR1 RCM is a leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems, and medical groups. We are seeking a skilled Physician Advisor to join our team.Key Responsibilities:Review payor peer-to-peer cases to ensure compliance with regulations and...
-
Clinical Reviewer
4 days ago
Detroit, Michigan, United States Umanist Staffing LLC Full timeJob Title: Clinical ReviewerUmanist Staffing LLC is seeking a skilled Clinical Reviewer to join our team. As a Clinical Reviewer, you will be responsible for reviewing inpatient, outpatient, and ambulatory services to ensure medical necessity, appropriate length of stay, intensity of service, and level of care.Key Responsibilities:Perform prospective,...
-
Clinical Reviewer
2 weeks ago
Detroit, Michigan, United States ICONMA Full timeJob Title: Registered Nurse-Review AnalysLocation: Detroit, MIDuration: 10-11 monthsDescription:We are seeking a highly skilled Registered Nurse to join our team as a Clinical Reviewer. In this role, you will be responsible for performing prospective, concurrent, and retrospective reviews of inpatient, outpatient, ambulatory, and ancillary services to ensure...
-
Clinical Review Specialist
4 weeks ago
Detroit, Michigan, United States Strategic Staffing Solutions Full timeStrategic Staffing Solutions Job OpportunityWe are seeking a skilled RN Review Analyst to join our team at Strategic Staffing Solutions.About the Role:Work with one of our largest clients located in Detroit, MI.Collaborate with healthcare professionals to ensure high-quality patient care.Analyze clinical data to identify trends and areas for...
-
Clinical Review Specialist
4 weeks ago
Detroit, Michigan, United States Strategic Staffing Solutions Full timeJob Title: Registered Nurse-Review AnalystJob Summary:Strategic Staffing Solutions is seeking a Registered Nurse-Review Analyst to join our team. As a key member of our healthcare team, you will be responsible for reviewing precertification admission and concurrent reviews for the appropriateness of the inpatient setting utilizing InterQual...
-
Clinical Utilization Reviewer
9 hours ago
Detroit, Michigan, United States Genex Services, LLC. Full timeGenex Service LLC is seeking a skilled Utilization Reviewer to join our team. As a Utilization Reviewer, you will be responsible for performing precertification reviews for New Jersey auto accident PIP medical treatment referrals. You will use your critical thinking and clinical judgment to ensure that treatment is medically necessary and authorized. This is...
-
Clinical Review Nurse
2 weeks ago
Detroit, Michigan, United States LanceSoft Full timeJob SummaryWe are seeking a highly skilled Clinical Review Nurse to join our team at LanceSoft. As a key member of our healthcare team, you will be responsible for conducting thorough medical necessity reviews of post-acute care services to ensure that patients receive the most appropriate care.Key ResponsibilitiesConduct prospective, concurrent, and...
-
Clinical Review Nurse
2 weeks ago
Detroit, Michigan, United States LanceSoft Full timeJob SummaryWe are seeking a highly skilled Clinical Review Nurse to join our team at LanceSoft. As a key member of our healthcare team, you will be responsible for performing prospective, concurrent, and retrospective medical necessity reviews of post-acute care services to ensure medical necessity for appropriate setting and length of stay.Key...
-
Clinical Reviewer
2 weeks ago
Detroit, Michigan, United States Genex Services, LLC. Full timeJob Title: Utilization ReviewerGenex Service LLC is seeking a skilled Utilization Reviewer to join our team. As a Utilization Reviewer, you will play a critical role in ensuring that medical treatment is necessary and appropriate for patients.Responsibilities:Perform utilization review of medical treatment requests to determine medical necessity.Collaborate...
-
Nurse Review Specialist
3 days ago
Detroit, Michigan, United States Umanist Staffing LLC Full timeJob Title: Registered Nurse Review AnalystUmanist Staffing LLC is seeking a highly skilled Registered Nurse to join our team as a Review Analyst. In this role, you will be responsible for conducting thorough reviews of inpatient, outpatient, and ambulatory services to ensure medical necessity, appropriate length of stay, and level of care.Key...
-
Drug Utilization Review Specialist
3 weeks ago
Detroit, Michigan, United States destinationone Consulting Full timeJob Title: Drug Utilization Review SpecialistAt destinationone Consulting, we are seeking a highly skilled Drug Utilization Review Specialist to join our team. As a key member of our healthcare recruitment team, you will play a crucial role in evaluating medication use patterns to promote safe and effective medication therapy, ensuring optimal patient...
-
Drug Utilization Review Specialist
3 days ago
Detroit, Michigan, United States destinationone Consulting Full timeJob Title: Drug Utilization Review SpecialistDestinationone Consulting is seeking a highly skilled Drug Utilization Review Specialist to join our team. As a key member of our healthcare recruitment team, you will play a critical role in evaluating medication use patterns to promote safe and effective medication therapy.Key Responsibilities:Conduct...
-
Nurse Review Specialist
3 days ago
Detroit, Michigan, United States w3r Consulting Full timeJob Title: Registered Nurse Review AnalystDuration: 10 monthsLocation: RemotePay: $40.00/hr on W2As a Registered Nurse Review Analyst, you will be responsible for performing prospective, concurrent, and retrospective reviews of inpatient, outpatient, ambulatory, and ancillary services to ensure medical necessity, appropriate length of stay, intensity of...
-
Clinical Research Nurse
5 hours ago
Detroit, Michigan, United States WEP Clinical Full timeMobile Research Nurse Job DescriptionWe are seeking a skilled and compassionate nurse with a passion for clinical research to join our dynamic team as a Mobile Research Nurse. As a key member of our team, you will play a crucial role in ensuring the successful execution of research studies.Key Responsibilities:Administer investigational medications/products...
-
RN Utilization Review Specialist
4 weeks ago
Detroit, Michigan, United States Detroit Medical Center Shared Services Full timeJob SummaryWe are seeking a skilled RN Utilization Review Specialist to join our team at the Detroit Medical Center Shared Services. As a key member of our case management team, you will play a critical role in ensuring that patients receive the most appropriate level of care while promoting efficient resource utilization.Key ResponsibilitiesFacilitate...
-
Nurse Review Specialist
2 weeks ago
Detroit, Michigan, United States PSG Global Solutions Careers Full timeJob OpportunityWe are seeking a skilled Registered Nurse to join our team as a Review Analyst in the Insurance industry in Detroit, Michigan, United States.About the RoleThis is a challenging and rewarding opportunity to work with our client, a fast-growing industry-recognized staffing firm. As a Review Analyst, you will be responsible for performing...