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Medical Necessity Analyst

3 weeks ago

Detroit, Michigan, United States PSG Global Solutions Careers Full time
Role Summary

We are seeking a detail-oriented Medical Necessity Analyst to join our team in the Insurance industry in Detroit, Michigan.

In this role, you will work closely with cross-functional teams to ensure that post-acute care services are medically necessary and appropriate for patients.

About Our Client

PSG Global Solutions Careers is a fast-growing staffing firm with 20+ years of experience and growth.

We specialize in connecting top professionals with premier organizations across various industries, including Automotive, Healthcare, Retail, Financial & Insurance, and Professional & Business Services.

Key Responsibilities
  • Conduct thorough medical necessity reviews of post-acute care services to ensure alignment with established medical policy and guidelines.
  • Collaborate with healthcare providers, facilities, and members to coordinate care and provide support for alternative care options.
  • Develop and implement effective discharge plans to ensure smooth transitions from post-acute care settings to lower levels of care.
Requirements

To be successful in this role, you will need:

  • Bachelor's degree in nursing or related field (preferred)
  • 2-4 years of clinical experience, including post-acute care, home care, acute patient care, discharge planning, case management, utilization review, and caring for aging populations.
  • Demonstrated clinical knowledge and experience relative to patient care and healthcare delivery processes.
  • Registered Nurse with current unrestricted Michigan Registered Nurse license required.
Compensation and Benefits

The estimated salary for this role is $70,000 - $90,000 per annum, depending on experience.