Healthcare Review Specialist

2 weeks ago


Detroit, Michigan, United States W3R Consulting Full time

Position Title: Clinical Review Nurse

Company: W3R Consulting

Job Overview:

This role involves conducting comprehensive evaluations of inpatient, outpatient, and ancillary services to ensure medical necessity and appropriate care levels. The Clinical Review Nurse will play a crucial role in establishing care plans and coordinating patient care throughout the healthcare continuum.

Key Responsibilities:

  • Perform prospective, concurrent, and retrospective reviews of medical services.
  • Assess appeal requests initiated by healthcare providers and members.
  • Coordinate care through outreach assessments and care plan development.

Essential Qualifications:

  • Active and unrestricted Registered Nurse license in Michigan.
  • Two to four years of clinical experience in areas such as acute care, discharge planning, or case management.
  • Strong clinical knowledge related to patient care and healthcare delivery processes.

Preferred Qualifications:

  • Bachelor's degree in nursing or a related field.
  • Experience in a health insurance plan or managed care environment.

Skills Required:

  • Proficient computer skills, particularly in Microsoft Office.
  • Clinical experience in ICU, ER, or medical-surgical units is preferred.
  • Experience in utilization management is an advantage.

Engagement Details:

This position offers a competitive hourly rate and the opportunity to work in a dynamic and supportive environment focused on improving patient care outcomes.



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