Job Description

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: 10+ Months

Job Type: Contract

Work Type: Remote

Dept: MA Post-Acute Care UM

Job Description:

• Perform prospective, concurrent and retrospective review of post-acute care 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:

• Above average computer skills (Microsoft office).
• Clinical experience in SNF, LTAC or IPR preferred.
• Prefer utilization management experience.

Required Skills/Experience The rest of the required skills/experience. Include:

• Registered Nurse with current unrestricted Michigan Registered Nurse license required.
• 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.

Preferred Skills/Experience Optional but preferred skills/experience. Include:

• Bachelor's degree in nursing, allied health, business, or related field preferred.
• One (1) year health insurance plan experience or managed care environment preferred.

Education/Certifications Include:

• Current unrestricted Michigan Registered Nurse license required.

TekWissen Group is an equal opportunity employer supporting workforce diversity.

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