Registered Nurse-Review Analys

Overview

Tek Wissen is a global workforce management provider headquartered in Ann Arbor, Michigan that offers strategic talent solutions to our clients world-wide. Our client is a health insurance company. It offers different types of health care coverage plans that include individual and family, dental and vision, plans for employers, etc.

Registered Nurse-Review Analys

Detroit, MI, 48226

10 Months

Contract

Hybrid (one day a week)

Medicare Medical Policy

• Develop and maintain Medicare Medical Policies ensuring policies are approved, implemented, and placed in repository, including annual reviews/updates
• Collaboration with Medical Director on medical policy development and maintenance
• Assist with the review of commercial medical policy meeting minutes to update Medicare Policies where needed
• Supporting the preparation of policies and documents for Criteria Review Commitee and Utilization Management Committee Meetings
• Research CPT or HCPCS codes as needed
• Researching medical technologies as needed for specific cases requesting authorizations on technologies
• Familiar with Microsoft Office products
• Respond to inquiries from other teams.

• Experience in Medicare and managed care health insurance medical policy.
• Strong written communication skills: ability to write clear and concise documents
• Experience with collaborative projects

• Research, gather, plan, organize and evaluate information from multiple sources
• Knowledge of CPT and HCPCS codes
• Critical thinking and problem-solving skills
• Clinical experience
• Familiar with Microsoft Office products

• Experience with medical Billing/Coding
• Knowledge of CMS Medicare coverage guidance
• Experience in maintaining a repository of documents.
• Registered nurse with 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.