Registered Nurse-Review Analys

Registered Nurse Review Analyst

Remote

12-Month Contract

MA Inpatient Precertification

$30-$40/hour

• Fully Remote
• No onsite requirements anticipated during the assignment.

• We are seeking a Registered Nurse Review Analyst to support inpatient precertification and utilization management activities in a fully remote environment.
• This role is responsible for performing prospective, concurrent, and retrospective medical reviews to determine medical necessity, appropriate level of care, intensity of service, and length of stay for healthcare services.
• The ideal candidate will have a strong clinical background, experience evaluating patient care needs, and the ability to collaborate with providers, facilities, and members to support quality healthcare outcomes.

• Perform prospective, concurrent, and retrospective reviews of inpatient, outpatient, ambulatory, and ancillary healthcare services.
• Evaluate medical necessity, level of care, intensity of service, and appropriate length of stay.
• Review and assess appeal requests submitted by providers, facilities, and members.
• Apply clinical knowledge and evidence-based guidelines to utilization review decisions.
• Establish care plans and coordinate care across the healthcare continuum when appropriate.
• Conduct member outreach and assessments to support care coordination initiatives.
• Collaborate with physicians, healthcare providers, and interdisciplinary teams to facilitate quality patient care.
• Maintain accurate documentation and comply with organizational policies, regulatory requirements, and utilization management standards.

• Active, unrestricted Michigan Registered Nurse (RN) license.
• 2-4 years of clinical nursing experience.
• Demonstrated clinical knowledge related to patient care and healthcare delivery processes.
• Experience in one or more of the following areas:
  • Acute patient care
  • Discharge planning
  • Case management
  • Utilization review
• Strong analytical, problem-solving, and communication skills.
• Ability to work independently in a remote setting.

• Bachelor's degree in Nursing, Allied Health, Business, or a related field.
• Experience working with a health insurance plan or managed care organization.
• Certification in Case Management (CCM) or related certification.
• Prior experience in utilization management, precertification, or medical review environments.

• Utilization Review
• Medical Necessity Review
• Inpatient Precertification
• Care Coordination
• Case Management
• Appeals Review
• Clinical Assessment
• Healthcare Compliance
• Managed Care
• Documentation Review
• Patient Care Management
• Healthcare Operations