Registered Nurse - Review Analyst

Requested criteria: Above average computer skills (Microsoft office). Clinical experience in ICU, ER, or medical surgical unit preferred. Prefer utilization management experience. Resource will be able to perform this role offsite. May be required to come into the office for meetings and training.

Engagement Description -
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.

Top 3 Required Skills/Experience -
• 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.
• Registered Nurse with current unrestricted Michigan Registered Nurse license required.

Required Skills/Experience - The rest of the required skills/experience. Include:
• Above average computer skills (Microsoft office).
• Clinical experience in ICU, ER, or medical surgical unit preferred.
• Resource will be able to perform this role offsite. May be required to come into the office for meetings and training.

Preferred Skills/Experience - Optional but preferred skills/experience. Include:
• One (1) year health insurance plan experience or managed care environment preferred.
• Certification in Case Management may be preferred based upon designated department assignment.

Education/Certifications - Include:
• Bachelor's degree in nursing, allied health, business, or related field preferred.
• Registered Nurse with current unrestricted Michigan Registered Nurse license required.
• One (1) year health insurance plan experience or managed care environment preferred.
• Certification in Case Management may be preferred based upon designated department assignment.