Utilization Management RN - Post Acute Care

We're Hiring: Utilization Management RN - Post Acute Care!

We are seeking an experienced Registered Nurse to join our team as a Utilization Management Nurse focusing on Medicare Advantage Post-Acute Care. The ideal candidate will use established medical policies and guidelines to perform prospective, concurrent, and retrospective medical necessity reviews of post-acute care services. This role ensures appropriate care setting, length of stay, and manages appeal requests initiated by providers, facilities, and members. The nurse will coordinate care across the healthcare continuum, including member outreach, and provide support for alternative care options for members who are not appropriate for post-acute care services. Additionally, the nurse will assess discharge readiness for members transitioning from post-acute care to a lower level of care.

Location: Detroit, MI
Role: Utilization Management RN - Post Acute Care
Duration: 6 months

Qualifications:

• Bachelor’s degree in Nursing, Allied Health, Business, or related field preferred.
• 2 to 4 years of clinical experience, including post-acute care, home care, acute patient care, discharge planning, case management, utilization review, or caring for the aging population in home or post-acute settings.
• Demonstrated clinical knowledge and experience in patient care and healthcare delivery processes.
• Minimum of 1 year experience in a health insurance plan or managed care environment preferred.
• Registered Nurse (RN) with a current, unrestricted Michigan nursing license required.

Preferred Skills and Experience:

• Understanding of Medicare requirements for skilled versus non-skilled services in post-acute care and home settings.
• Certification in Case Management.
• Experience managing patients with compromised airways requiring skilled services.
• Experience with goal planning and interventions for patients recovering from unplanned or prolonged hospital admissions, including but not limited to stroke, hip and femur fractures requiring surgical intervention after a fall, sepsis, ventilator dependency, or significant changes in functional ability.

Ready to make an impact in healthcare? 🚀 Apply now and join our team!