Location: Remote (Detroit, MI)

Duration: 3 Months with possible extension  Shift: 8am-5pm EST, Mon-Fri Travel Required: Onsite for some Quarterly meeting

Description/Summary: Nurse who's familiar with coding and medical reviews, where they can review a medical chart and decide if the medical procedure or test is necessary for the patient.  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.

In this role, you would be responsible for: Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes. Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical needs. Provide patient and provider education.

Requirement:   O Bachelor's degree in nursing, allied health, business, or related field preferred.  O Two (2) to four (4) years of clinical experience which may include acute patient care, discharge planning, case management, and utilization review, etc.  O Demonstrated clinical knowledge and experience relative to patient care and health care delivery processes.  O One (1) year health insurance plan experience or managed care environment preferred.  O Registered Nurse with current unrestricted Michigan Registered Nurse license required.  O Certification in Case Management may be preferred based upon designated department assignment.  O Requested criteria above average computer skills (Microsoft Office suite - WORD, EXCEL, AND OUTLOOK).  O Reliable internet access with at least 100 Mbps download speed, and 10 Mbps upload speed.