About the opportunity
We are seeking a Michigan RN - Remote Utilization Management:
Perform prospective, concurrent and retrospective review of inpatient, outpatient, ambulatory and ancillary 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.
Requirements:
Perform prospective, concurrent and retrospective review of inpatient, outpatient, ambulatory and ancillary 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.
Requirements:
- RN - unrestricted Michigan Registered Nurse license required
- 2-4 years of clinical experience - acute patient care, discharge planning, case management, and utilization review
- Clinical experience in ICU, ER, or medical surgical unit preferred.
- Utilization management experience preferred
- 1 year health insurance plan experience or managed care environment preferred.
- Computer - MS Office, Type 35+WPM, Dual monitors, multiple systems
- Demonstrated clinical knowledge and experience relative to patient care and health care delivery processes.
