Registered Nurse-Review Analyst (9 Of 25)

Job Title: Registered Nurse-Review Analyst

Why work at OpTech?

OpTech is a woman-owned company that values your ideas, encourages your growth, and always has your back. When you work at OpTech, not only do you get health and dental benefits on the first day of employment, but you also have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. Apply today! To view our complete list of openings, please visit our website at www.optechus.com.

RESPONSIBILITIES:

• Use established medical policy and guidelines to perform prospective, concurrent, and retrospective medical necessity review of post-acute care services to ensure medical necessity for appropriate setting, appropriate length of stay, including appeal requests initiated by providers, facilities and members

• Will coordinate care through the health care continuum including member outreach

• Provides support and alternative care support for member not appropriate for post-acute care service as well formulate discharge readiness for members transitioning from a post-acute care setting to a lower level of care

QUALIFICATIONS:

• Two (2) to four (4) years of clinical experience which may include post-acute care, home care, acute patient care, discharge planning, case management, and utilization review, and caring for aging population in the home or post-acute care setting, 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

• The following skills are not required, but may be preferred depending on assignment:

• Understanding Medicare Requirements for skilled vs non-skilled services in post-acute care and home setting

• Certification in Case Management

• Experience with management of patients with compromised airways requiring skilled services

• Experience with goals planning and intervention for patients recovering after unplanned or prolonged hospital admission including but not limited to stroke, hip and femur fractures with surgical intervention after a fall, sepsis, ventilator dependency, and sever change in functional ability

EDUCATION:

• Bachelor's degree in nursing, allied health, business, or related field preferred

CERTIFICATION:

• Registered Nurse with current unrestricted Michigan Registered Nurse license required

OpTech is an equal opportunity employer and is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, status as a parent, disability, age, veteran status, or other characteristics as defined by federal, state or local laws. https://www.optechus.com/eeo_self_identification/

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