Utilization Review RN at Strategic Staffing Solutions
Detroit, MI
About the Job
STRATEGIC STAFFING SOLUTIONS (S3) HAS AN OPENING!
Strategic Staffing Solutions is currently looking for Utilization Review RNs for a contract opportunity with one of our largest clients located in Detroit, MI!
Title: Utilization Review RN - multiple openings
Location: Detroit, MI
Duration: 12+ Months
Role Type: W2 contract engagement
ROLE SUMMARY
UM - Utilization Management
• Medicare Advantage Post-Acute Care RN:
• 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.
Requirements:
• Bachelor’s degree in nursing, allied health, business, or related field preferred.
• 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.
• Registered Nurse with current unrestricted Michigan Registered Nurse license required.
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, sever change in functional ability.
The S3 Difference
The global mission of S3 is to build trusting relationships and deliver solutions that positively impact our customers, our consultants, and our communities. The four pillars of our company are to:
• Set the bar high for what a company should do
• Create jobs
• Offer people an opportunity to succeed and change their station in life
• Improve the communities where we live and work through volunteering and charitable giving
As an S3 employee, you’re eligible for a full benefits package that may include:
• Medical Insurance
• Dental Insurance
• Vision Insurance
• 401(k) Plan
• Vacation Package
• Life & Disability Insurance Plans
• Flexible Spending Accounts
• Tuition Reimbursement
