Overview :
TekWissen is a global workforce management provider headquartered in Ann Arbor, Michigan that offers strategic talent solutions to our clients world-wide. Our client is a health insurance company. It offers different types of health care coverage plans that include individual and family, dental and vision, plans for employers, etc.
Title: Registered Nurse-Review Analys
Work Location: Detroit, MI, 48243
Duration: 12 Months
Job Type: Contract
Work Type: Remote
Dept: Commercial Inpatient Pr
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.
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.
Top 3 Required Skills/Experience
2 years acute care experience with an unrestricted Registered Nurse license
ICU/ER preferred or for post-acute care positions SNF/Rehab/LTACH) *should not just be 2 years in a specialized field such as NICU/OB/BH/Substance Abuse *
Advanced computer skills
Required Skills/Experience The rest of the required skills/experience. Include:
Preferred Skills/Experience Optional but preferred skills/experience. Include:
InterQual/MCG or other utilization review experience
Advanced computer skills
40+ WPM typing
Education/Certifications Include:
Registered Nurse License
TekWissen Group is an equal opportunity employer supporting workforce diversity.
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