Review Analyst-Registered Nurse
Location:
Remote but looking for candidates in MI-MUST HAVE A MI NURSING LICENSE
Schedule:
Monday-Friday
Type:
W2 Contract
Duration:
Long term on-going contract
Pay Rate:
$36-$39 an hour
Work Location
- Remote position
- Contractor will be required to come onsite for one day of training to:
- Receive their company laptop
- Attend in-person onboarding/training
- Note: Onsite requirements could change in the future if directed by executive leadership.
Position Summary
Responsible for performing prospective, concurrent, and retrospective utilization reviews of inpatient, outpatient, ambulatory, and ancillary services to ensure:
- Medical necessity
- Appropriate length of stay
- Intensity of service
- Appropriate level of care
Additional responsibilities include:
- Reviewing appeal requests submitted by providers, facilities, and members
- Developing care plans as needed
- Coordinating care across the healthcare continuum
- Conducting member outreach and assessments
Required Qualifications
- Registered Nurse (RN) with a current, unrestricted Michigan RN license
- 2 to 4 years of clinical experience, which may include:
- Acute patient care
- Discharge planning
- Case management
- Utilization review
- Strong clinical knowledge of patient care and healthcare delivery processes
- Above-average computer skills, including Microsoft Office
Preferred Qualifications
- Bachelor’s degree in Nursing, Allied Health, Business, or a related field
- 1+ year of experience in a health insurance plan or managed care environment
- Clinical experience in:
- Intensive Care Unit (ICU)
- Emergency Room (ER)
- Medical-Surgical Unit
- Prior utilization management experience
- Case Management Certification (depending on department assignment)
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