RN Review Analyst
500 Renaissance Center Detroit, MI 48243
Hours: Mon - Fri 8a-5p
Benefits: Medical, Dental, Vision, Short-Term Disability and Life Insurance available after 90 Days completed employment. 401k with Matching available after 1 year.
Registered Nurse Duties:
- Responsible for reviewing claims data to ensure providers are meeting PPO network utilization standards, identifying outliers, working with providers on corrective action, monitoring compliance to the corrective action plan, responding to inquiries, presenting cases at various committees and other duties assigned.
- Responsible for the review of PPO provider utilization to ensure network providers are meeting PPO utilization standards.
- Will be required to enter or reference data via PC.
- Analyst experience required with proven experience in data analysis and problem resolution type activities.
- Associate Degree or nursing diploma required.
- Two (2) years patient care experience. Triage, case management and/or rehabilitation experience preferred.
- Ability to plan, organize, direct and control one’ s work.
- Excellent written and verbal communication skills.
- Excellent Computer Skills - MS Office
- Expertise in the use of medical terminology.