Registered Nurse-Review Analyst

Job Title: Registered Nurse-Review Analyst

Why work at OpTech?
OpTech is a woman-owned company that values your ideas, encourages your growth, and always has your back. When you work at OpTech, not only do you get health and dental benefits on the first day of employment, but you also have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. Apply today! To view our complete list of openings, please visit our website at www.optechus.com .

RESPONSIBILITIES:

• Responsible for the review of precertification admission and concurrent reviews for the appropriateness of the inpatient setting utilizing InterQual criteria
• Required to enter or reference data via PC, collaborate with facilities, providers and Medical Directors
• Some weekends and corporate holidays
• Work from home position, may require some travel to the office when necessary

QUALIFICATIONS:

Top 3 Required Skills/Experience:

2 years acute care experience with an unrestricted Registered Nurse license

ICU/ER preferred *should not just be 2 years in a specialized field such as NICU/OB/BH/Substance Abuse *

InterQual/MCG or other utilization review experience

Required Skills/Experience:

• Advanced computer skills
• 40+ WPM typing
• Good verbal and written communication skills
• At least two (2) years patient care experience
• Expertise in the use of medical terminology
• Must have excellent written and oral communication skills
• 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
• Other related skills may be required to perform this job

Preferred Skills/Experience:

• Utilization Review experience at a previous insurance company (medical, surgical admissions)
• Utilization Review experience in an acute care setting
• Triage, case management, emergency room or ICU experience or utilization review experience with an insurance company preferred
• InterQual knowledge preferred
• One (1) year health insurance plan experience or managed care environment preferred

Education/Certifications - Include:

• Must be a RN with an unrestricted Registered Nurse license
• Registered Nurse with current Michigan driver's license
• Associate Degree or nursing diploma required
• Registered Nurse with current unrestricted Michigan Registered Nurse license required

OpTech is an equal opportunity employer and is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, status as a parent, disability, age, veteran status, or other characteristics as defined by federal, state or local laws. https://www.optechus.com/eeo_self_identification/

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