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Clinical Review Specialist

1 month ago

Detroit, Michigan, United States W3R Consulting Full time
Job Title - Registered Nurse - Clinical Review

Duration - 10 months

Location - Remote

Pay: $40.00/hr on W2

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 clinical reviews to ensure medical necessity and appropriateness of care
  • Develop and implement care plans to coordinate care through the healthcare continuum
  • Collaborate with healthcare providers and facilities to ensure high-quality care
  • Conduct retrospective reviews to identify areas for improvement

Requirements:

  • Current unrestricted Michigan Registered Nurse license
  • Two to four years of clinical experience, including acute patient care, discharge planning, case management, and utilization review
  • Demonstrated clinical knowledge and experience relative to patient care and healthcare delivery processes

Preferred Qualifications:

  • Bachelor's degree in nursing, allied health, business, or related field
  • One year of health insurance plan experience or managed care environment

We offer a competitive salary and benefits package. If you are a motivated and detail-oriented Registered Nurse with a passion for clinical review, please submit your application.