Registered Nurse-Review Analyst

Title:  Registered Nurse-Review Analyst 

Work Location: Detroit, MI, 48226

Duration: 10 Months   

Job Type: Contract  

Work Type: Hybrid (one day a week) 

Dept: Medicare Medical Policy

Pay: $30-$34 per Hour on W2

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.