Utilization Review Nurse

<p><strong>Job Description </strong></p><ul><li>Use established medical policy and guidelines to perform prospective, concurrent, and retrospective medical necessity review of post-acute care services to ensure medical necessity for appropriate setting, appropriate length of stay, including appeal requests initiated by providers, facilities and members.</li><li>Will coordinate care through the health care continuum including member outreach.</li><li>Provides support and alternative care support for members not appropriate for post-acute care service as well formulate discharge readiness for members transitioning from a post-acute care setting to a lower level of care.</li><li><strong>Should have experience with InterQual</strong></li></ul><p><strong>Requirement:</strong></p><ul><li>Bachelor’s degree in nursing, allied health, business, or related field preferred.</li><li>Two to four years of clinical experience which may include post-acute care, home care, acute patient care, discharge planning, case management, and utilization review, and caring for aging population in the home or post-acute care setting, etc.</li><li>Demonstrated clinical knowledge and experience relative to patient care and health care delivery processes.</li><li>One year health insurance plan experience or managed care environment preferred.</li><li>Registered Nurse with current unrestricted Michigan Registered Nurse license required.</li></ul><p><br></p>