Medicare Advantage RN Review Analyst

Medicare Advantage RN Review Analyst

Location: Detroit, MI (Remote however must be local to Michigan)

Duration: 12+ Months with opportunity for FTE

Role Type: W2 Contract role

Max Pay Rate: $36/HR

Schedule: Monday - Friday 9-5

SUMMARY

Responsible for the approval or rejection of claims and/or benefit interpretation. May be required to enter or reference data via PC and/or Clinical Review Team terminal.

REQUIREMENTS

• Registered Nurse with current Michigan Registered Nurse License.
• Associate degree or nursing diploma required, bachelor’s degree preferred.
• Two (2) years RN patient care experience.
• Triage, case management and/or rehabilitation experience preferred.
• Medicare Advantage Part B experience a plus.
• Expertise in the use of medical terminology.
• Finely honed critical thinking skills are a must.
• Knowledge of CPT/HCPCS coding and Medicare regulations desirable.

CERTIFICATES, LICENSES, REGISTRATIONS

• Current unrestricted state of Michigan registered nurse license required.