RN Review Analyst

Detroit, MI 48243

Posted: 02/20/2019 Category: Registered Nurse Job Number: 25184
A-Line Staffing is hiring a Registered Nurse to do Retrospective Claims Reviews.  The ideal candidate will have experience with Utilization Review, Claims Analysis, and/or HEDIS.    Please contact Aaron Smith at 877-782-3334 x234 or asmith@alinestaffing.com 

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.
Registered Nurse Requirements:
  • 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.

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