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Two (2) to four (4) years of clinical experience which may include acute patient care, discharge planning, case management, and utilization review, etc. Title: Registered Nurse-Review Analys.
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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.
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Knowledge of computers, Electronic Health Records, data base systems and utilization review/case management documentation systems. Registered Nurse (RN) with a valid, unrestricted State of Michigan license required.
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Triage, case management and/or utilization review experience preferred. - InterQual or Utilization review experience. Registered Nurse-Review Analyst. Triage, case management and/or utilization review experience preferred.
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RN, registered nurse, home care, home health, nurse, nursing, case manager, oncology, OCN, oncology certified nurse, case management acute care, clinical, hospital, healthcare, discharge planning, assessment, care plans, managed care, insurance, health plan, certified case manager, CCM, disease management, utilization review.
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Department orientation includes review and instruction regarding Tenet Case Management and Compliance policies, InterQual, Transition Management, Utilization Management, and other topics specific to case management.
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