Registered Nurse-Review Analys

Use established medical policy and guidelines to perform prospective concurrent and retrospective medical necessity review of postacute care services to ensure medical necessity for appropriate setting appropriate length of stay including appeal requests initiated by providers facilities and members.

Will coordinate care through the health care continuum including member outreach.

Provides support and alternative care support for member not appropriate for postacute care service as well formulate discharge readiness for members transitioning from a postacute care setting to a lower level of care.

Bachelors degree in nursing allied health business or related field preferred.

Two (2) to four (4) years of clinical experience which may include postacute care home care acute patient care discharge planning case management and utilization review and caring for aging population in the home or postacute care setting etc.

Demonstrated clinical knowledge and experience relative to patient care and health care delivery processes.

One (1) year health insurance plan experience or managed care environment preferred. Registered Nurse with current unrestricted Michigan Registered Nurse license required.

The following skills are not required but may be preferred depending on assignment: understanding Medicare Requirements for skilled vs nonskilled services in postacute care and home setting certification in Case Management experience with management of patients with compromised airways requiring skilled services experience with goals planning and intervention for patients recovering after unplanned or prolonged hospital admission including but not limited to stroke hip and femur fractures with surgical intervention after a fall sepsis ventilator dependency sever change in functional ability.