Clinical Review Specialist
4 days ago
Location: Detroit, MI
Duration: 10-11 months
Description:
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 ancillary services to ensure medical necessity, appropriate length of stay, intensity of service, and level of care.
Key Responsibilities:
- Perform reviews of healthcare services to ensure medical necessity and appropriateness
- Develop and implement care plans to coordinate care through the healthcare continuum
- Collaborate with healthcare providers, facilities, and members to ensure high-quality care
- Conduct outreach assessments to engage members in their care
- Develop and maintain knowledge of healthcare policies, procedures, and regulations
Requirements:
- Bachelor's degree in nursing, allied health, business, or related field
- Two to four years of clinical experience in ICU, ER, or medical surgical unit
- Above average computer skills (Microsoft Office)
- Registered Nurse with current unrestricted Michigan Registered Nurse license
Preferred Qualifications:
- One year of health insurance plan experience or managed care environment
- Certification in Case Management
What We Offer:
At ICONMA, we are committed to providing a work environment that supports and encourages the abilities of all persons without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
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