Medical Professional for Utilization Review
Posted 2025-03-14About 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 healthcare coverage plans including individual and family dental and vision plans for employers.
Job Overview
We are seeking an experienced Registered Nurse to perform 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. This includes appeal requests initiated by providers, facilities, and members.
Responsibilities
? Establish care plans and coordinate care through the healthcare continuum, including member outreach assessments.
? Utilize clinical knowledge and experience relative to patient care and healthcare delivery processes.
? Analyze medical records and make informed decisions regarding medical necessity.
Requirements
? Registered Nurse with current 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.
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