RN Review Analyst

Dept: MA Inpatient Precertifi

Will this position be required to work onsite for any reason at any time? Remote. We're planning to have the contractor come on site for one day during training to receive their laptop and attend in-person training. However, there's a potential this can change if we are given a specific directive from executive leadership.

Perform prospective, concurrent and retrospective review of inpatient, outpatient, ambulatory and ancillary services to ensure medical necessity, appropriate length of stay, intensity of service and level of care, including appeal requests initiated by providers, facilities and members. May establish care plans and coordinate care through the health care continuum including member outreach assessments. Bachelor's degree in nursing, allied health, business, or related field preferred. Two (2) to four (4) years of clinical experience which may include acute patient care, discharge planning, case management, and utilization review, etc. Demonstrated clinical knowledge and experience relative to patient care and health care delivery processes. One (1) year health insurance plan experience or managed care environment preferred. Registered Nurse with current unrestricted Michigan Registered Nurse license required. Certification in Case Management may be preferred based upon designated department assignment.

Requested criteria: Above average computer skills (Microsoft office). Clinical experience in ICU, ER, or medical surgical unit preferred. Prefer utilization management experience.