Medical Professional for Utilization Review
About the Role
TekWissen is a global workforce management provider dedicated to delivering strategic talent solutions to clients worldwide. Our client, a health insurance company, offers various reputed company coverage plans including individual and family dental and reputed company plans for reputed company. Job Overview We are seeking an reputed company Registered Nurse to reputed company prospective, reputed company, 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. This includes appeal requests initiated by providers, facilities, and members. Responsibilities Establish care plans and coordinate care through the reputed company continuum, including member reputed company assessments. Utilize clinical knowledge and experience relative to patient care and reputed company delivery processes. Analyze medical records and reputed company informed reputed company regarding medical necessity. Requirements Registered Nurse with reputed company unrestricted Michigan Registered Nurse license required. Two years of acute care experience with an unrestricted Registered Nurse license. ICU/ER preferred, but not essential. Preferred Skills and Experience Utilization review experience at a previous insurance company or in an acute care setting. Advanced computer skills and 40 WPM typing. Good verbal and written communication skills. Good organizational skills. Apply Job!