Registered Nurse - Review Analyst

Job Title: Registered Nurse-Review Analyst

Location: Detroit, MI United States

Hybrid

Contract

Job Description:

Why work at OpTech?

OpTech is a woman-owned company that values your ideas, encourages your growth, and always has your back. When you work at OpTech, not only do you get health and dental benefits, but you also have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. 

RESPONSIBILITIES:

• 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

QUALIFICATIONS:

Requested Criteria:

• Above average computer skills (Microsoft office)
• Clinical experience in ICU, ER, or medical surgical unit preferred
• Prefer utilization management experience

More Qualifications:

• 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

Education/Certification:

• Bachelor's degree in nursing, allied health, business, or related field preferred
• Registered Nurse with current unrestricted Michigan Registered Nurse license required
• Certification in Case Management may be preferred based upon designated department assignment

OpTech is an equal opportunity employer and is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, status as a parent, disability, age, veteran status, or other characteristics as defined by federal, state or local laws.