Healthcare Review Specialist
2 weeks ago
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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