RN Review Analyst

Detroit, MI 48226

Posted: 02/22/2019 Category: Registered Nurse Job Number: 25241

RN MEDICAL NECESSITY REVIEW

The Registered Nurse will telephonically provide appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate medical director with recommendations for other determinations. Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to medical directors for review depending on case findings. Educate providers on utilization and medical management processes. Train new employees on the appeals and re-certification process as needed.  *Will require work on weekends (8-hour day shift)*

REGISTERED NURSE QUALIFICATIONS:
  • Active RN License in the State of Michigan
  • Associate Degree Required
  • 3+ years of acute care/clinical experience                                          
  • Knowledge of managed care preferred

WHAT’ S GREAT ABOUT THIS POSITION?
  • Opportunity to step away from the bedside/direct patient care
  • Telephonic office-based position
  • Benefits offered!- Medical, Dental, Vision + Matching 401k
  • Remote/work from home options available after 12 months

PLEASE CONTACT: ALLISTON BROWN / 877-782-3334, EXT. 229

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