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Registered Nurse-Review Analys
Registered Nurse-Review AnalysTekwissen • Detroit, MI, United States
Registered Nurse-Review Analys

Registered Nurse-Review Analys

Tekwissen • Detroit, MI, United States
Hace más de 30 días
Tipo de contrato
  • A tiempo completo
Descripción del trabajo
Overview:

TekWissen is a global workforce management provider headquartered in Ann Arbor, Michigan that offers strategic talent solutions to our clients world-wide. Our client is a health insurance company. It offers different types of health care coverage plans that include individual and family, dental and vision, plans for employers, etc.

Title: Registered Nurse-Review Analys

Work Location: Detroit, MI, 48226

Duration: 10 Months

Job Type: Contract

Work Type: Hybrid (one day a week)

Dept: Medicare Medical Policy

Job Description:
  • Develop and maintain Medicare Medical Policies ensuring policies are approved, implemented, and placed in repository, including annual reviews/updates
  • Collaboration with Medical Director on medical policy development and maintenance
  • Assist with the review of commercial medical policy meeting minutes to update Medicare Policies where needed
  • Supporting the preparation of policies and documents for Criteria Review Commitee and Utilization Management Committee Meetings
  • Research CPT or HCPCS codes as needed
  • Researching medical technologies as needed for specific cases requesting authorizations on technologies
  • Familiar with Microsoft Office products
  • Respond to inquiries from other teams.
Top 3 Required Skills/Experience -
  • Experience in Medicare and managed care health insurance medical policy.
  • Strong written communication skills: ability to write clear and concise documents
  • Experience with collaborative projects
Required Skills/Experience - The rest of the required skills/experience. Include:
  • Research, gather, plan, organize and evaluate information from multiple sources
  • Knowledge of CPT and HCPCS codes
  • Critical thinking and problem-solving skills
  • Clinical experience
  • Familiar with Microsoft Office products
Preferred Skills/Experience - Optional but preferred skills/experience. Include:
  • Experience with medical Billing/Coding
  • Knowledge of CMS Medicare coverage guidance
  • Experience in maintaining a repository of documents.
  • Registered nurse with two (2) to four (4) years of clinical experience which may include acute patient care, discharge planning, case management, and utilization review, 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.

TekWissen® Group is an equal opportunity employer supporting workforce diversity.
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Registered Nurse-Review Analys • Detroit, MI, United States

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