RN Review Analyst

Dept. MA Post-Acute Care UM

Will this position be required to work onsite for any reason at any time? No

Engagement 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.