This range is provided by LanceSoft, Inc.. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.
Base pay range
$30.00/hr - $35.00/hr
Job Description
Use established medical policy and guidelines to perform prospective, concurrent, and retrospective medical necessity review of post-acute care services to ensure medical necessity for appropriate setting, appropriate length of stay, including appeal requests initiated by providers, facilities and members.
Will coordinate care through the health care continuum including member outreach.
Provides support and alternative care support for members not appropriate for post-acute care service as well formulate discharge readiness for members transitioning from a post-acute care setting to a lower level of care.
Should have experience with InterQual or MCG guidelines
Requirement:
Bachelor’s degree in nursing, allied health, business, or related field preferred.
Two to four years of clinical experience which may include post-acute care, home care, acute patient care, discharge planning, case management, and utilization review, and caring for aging population in the home or post-acute care setting, etc.
Demonstrated clinical knowledge and experience relative to patient care and health care delivery processes.
One year health insurance plan experience or managed care environment preferred.
Registered Nurse with current unrestricted Michigan Registered Nurse license required.
EEO Employer LanceSoft is a certified Minority Business Enterprise (MBE) and an equal opportunity employer. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. LanceSoft makes hiring decisions based solely on qualifications, merit, and business needs at the time.
Seniority level
Entry level
Employment type
Contract
Job function
Health Care Provider
Industries
IT Services and IT Consulting
Referrals increase your chances of interviewing at LanceSoft, Inc. by 2x