Job Title: Registered Nurse - Review Analyst

Contract Duration: 11 Months

Pay Rate: $40/hr

Location: Detroit, MI (Remote candidates must reside in Michigan)

Engagement Description

The Registered Nurse - Review Analyst is responsible for performing prospective, concurrent, and retrospective reviews of inpatient, outpatient, ambulatory, and ancillary services to ensure medical necessity, appropriate length of stay, intensity of service, and level of care. Responsibilities include managing appeal requests from providers, facilities, and members, as well as establishing care plans and coordinating care through the healthcare continuum, including member outreach assessments.

Top 3 Required Skills/Experience:

Clinical Experience: Minimum 2 years of acute care experience with a current, unrestricted Registered Nurse license.

ICU/ER experience preferred (not limited to specialized fields such as NICU, OB, Behavioral Health, or Substance Abuse).

Utilization Review Knowledge: Experience with InterQual/MCG or other utilization review tools preferred.
Technical Skills: Advanced computer skills and the ability to type 40+ WPM.

Required Skills/Experience:

Demonstrated clinical knowledge and experience in patient care and healthcare delivery processes.
Strong verbal and written communication skills.
Excellent organizational skills.

Preferred Skills/Experience:

Utilization review experience with a health insurance plan or managed care environment.
Previous utilization review experience in an acute care setting (e.g., medical, surgical admissions).

Education/Certifications:

Associate Degree or Nursing Diploma required.
Current and unrestricted Registered Nurse license in Michigan.

Other Requirements:

Triage, case management, or utilization review experience.
Expertise in medical terminology; InterQual knowledge preferred.
Availability for occasional weekends and corporate holidays.

W3R Consulting jobs

Registered Nurse - Review Analyst