Offer summary

Qualifications:

Bachelor's degree in nursing, allied health, business, or related field preferred., Registered Nurse with current unrestricted Michigan Registered Nurse license required., Two to four years of clinical experience in areas such as acute patient care, discharge planning, or case management., Certification in Case Management may be preferred based on department assignment..

Key responsabilities:

Perform prospective, concurrent, and retrospective reviews of various medical services to ensure medical necessity and appropriate care levels.

Establish care plans and coordinate care through the health care continuum, including member outreach assessments.

Handle appeal requests initiated by providers, facilities, and members.

Demonstrate clinical knowledge and experience related to patient care and health care delivery processes.

Kyyba, Inc. is a global workforce management and technology solutions firm headquartered in Farmington Hills, Michigan with multiple locations across the globe. Our expertise is in connecting the right people with the right opportunities. We deliver high-quality solutions and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances. Kyyba offers IT, Engineering, Professional, customized project solutions and Business Consulting Services. Industry areas include but are not limited to Automotive, Education, Financial Services, Public Services, Aerospace & Defense, Insurance, Transportation, Technology, Government, Healthcare & Medical, Manufacturing, and Oil & Energy.

Job description

Dept: Commercial Inpatient Pr

Will this position be required to work onsite for any reason at any time? No, resource will be able to perform this role offsite.

PLEASE ENSURE THE FOLLOWING QUESTIONS ARE ANSWERED AND PROVIDED IN THE RESOURCE'S RESUME.

1. Is your license in good standing?

2. Has anything come up in the last 5 years that would change the good standing of your license?

Perform prospective, concurrent and retrospective review of inpatient, outpatient, ambulatory and ancillary services to ensure medical necessity, appropriate length of stay, intensity of service and level of care, including appeal requests initiated by providers, facilities and members. May establish care plans and coordinate care through the health care continuum including member outreach assessments. Bachelor's degree in nursing, allied health, business, or related field preferred. 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. Certification in Case Management may be preferred based upon designated department assignment.