Nurse Review Specialist

2 weeks ago


Detroit, Michigan, United States PSG Global Solutions Careers Full time
Job Opportunity

We 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 Role

This 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 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.

Key Responsibilities
  • Use established medical policy and guidelines to perform medical necessity reviews
  • Coordinate care through the healthcare continuum, including member outreach
  • Provide support and alternative care support for members not appropriate for post-acute care services
  • Formulate discharge readiness for members transitioning from a post-acute care setting to a lower level of care
Requirements

To be successful in this role, you will need:

  • Bachelor's degree in nursing, allied health, business, or a related field
  • 2-4 years of clinical experience, including post-acute care, home care, acute patient care, discharge planning, case management, and utilization review
  • 1 year health insurance plan experience or managed care environment
  • Demonstrated clinical knowledge and experience relative to patient care and healthcare delivery processes
Preferred Skills

The following skills are not required but may be preferred depending on the assignment:

  • Understanding Medicare Requirements for skilled vs non-skilled services in post-acute care and home settings
  • 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
About 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, they are committed to bringing top talent together with premier organizations.

At PSG Global Solutions Careers, we value relationships based on mutual interest, resulting in low turnover, long-lasting partnerships, and growth. If you're looking for a company invested in your success, we encourage you to apply for this exciting opportunity.



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