Job Title: RN Review Analyst
About Kyyba:
Founded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances.
At Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development.
Job Description
Dept: Clinical Review
This role is offsite, work from home/Remote.
Responsibilities include providing clinical and educational support assessments, analysis, coordination of the quality and training management program, assisting in the divisional accreditation process, and conducting/assisting with internal and external audits.
Nursing Diploma or Associates Degree in Nursing required. Bachelor's degree in nursing (BSN) or related fields preferred. Registered Nurse with current unrestricted Michigan Registered Nurse license required. Five (5) years of experience in health-related fields required. Three (3) to five (5) years' experience with Care Management and/or Utilization Management. CM certification preferred.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
1. Responsible for educating staff in managed care as it relates to department programs, processes, and systems.
2. Conduct quality reviews on cases.
3. Develops, implements and updates training manuals reflecting new approaches to training, departmental and/or system process changes and InterQual criteria updates as needed.
4. Oversee and mentor new employees during the initial training program.
5. Work closely with the leadership team and subject matter experts external and internal to assess the learning environment and determine relevant resources for training.
6. Educate staff and external provider facilities in the clinical policies criteria and procedures of InterQual as well as an overview of the department, general functions, responsibilities, and department relationships with other departments.
7. Prepare all training materials and develop training packages with related materials assigned by leadership.
8. Participate in development, testing and implementation of new programs and systems as assigned.
9. Share performance information with operations and training management to determine next steps.
10. Coordinate administrative activities with the training supervisor and operations management, including class evaluations, updating files, class registration, scheduling classes, new hire system/software access, personnel information, and attendance management.
11. Coordinate and perform internal and external audits as required.
12. Travel may be required.
OTHER SKILLS AND ABILITIES
1. Effective analytical, verbal, and written communication skills.
2. Effective project management skills to create and execute work plans.
3. Ability to work independently and in a team environment.
4. Ability to manage multiple tasks.
5. Proficient in relevant PC applications (Share point, Care Advance, Microsoft Platforms – Excel, Word, Teams etc.).
6. Basic knowledge of ICD 10 and CPT Codes.
7. Member Health Record, VDA (Virtual Desktop), Care Advance.
8. Knowledge of local, state, and federal regulations (CMS, NCQA, PA60, HIPPA).
9. Ability to use clinical assessments and interventions.
10. Knowledge of effective communication techniques and theories.
11. Knowledge of utilization management and InterQual and/or MCG criteria.
12. Must be willing to act as a "change agent” on behalf of area and positively support the inception of new programs, systems, processes, software, and tools.
Location: (Detroit, MI)
Disclaimer:
Kyyba is an Equal Opportunity Employer.
Kyyba does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, ag e, non-disqualifying physical or mental disability, national origin, veteran status or any other basis covered by appropriate law. Minorities / Females / Protected Veterans / Individuals with Disabilities are encouraged to apply. All employment is decided on the basis of qualifications, merit, and business need.”
It is the policy of Kyyba to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact Kyyba at 248-813-9665
Rewards:
Medical, dental, vision
401k
Term life
Voluntary life and disability insurance
Optional Pre-paid legal plan
Optional Identity theft plan
Optional Medical and dependent FSA
Work-visa sponsorship
Opportunity for advancement
Long-term assignment with opportunity for hire by client
SELECT AWARDS
- An INC 5000 company for 10 years
- Corp! Michigan Economic Bright Spots
- Crain’s Detroit Business Top Staffing Service Companies in Detroit
- TechServe Alliance Excellence Award- IT and Engineering Staffing & Solutions
- Best of MichBusiness winner in HR Wizards & Partnerships
- Metro Detroit Elite Category: Recruitment, Selection & Orientation for 101 Best & Brightest
- 101 Best & Brightest Companies to Work for in Michigan
