Registered Nurse (Review Analyst)

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. Bachelor??s degree in nursing, allied health, business, or related field preferred. 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. One (1) year health insurance plan experience or managed care environment preferred. Registered Nurse with current unrestricted Michigan Registered Nurse license required. Certification in Case Management may be preferred based upon designated department assignment.