Tap Growth ai
Utilization Management RN - Post Acute Care
Tap Growth ai, Detroit, Michigan, United States, 48228
Position
Utilization Management RN – Post Acute Care (6‑month contract)
Location Detroit, MI
Overview We are seeking an experienced Registered Nurse to join our team as a Utilization Management Nurse focusing on Medicare Advantage Post‑Acute Care. The nurse will use established medical policies and guidelines to perform prospective, concurrent, and retrospective medical necessity reviews of post‑acute care services, ensuring appropriate care setting, length of stay, and managing appeal requests initiated by providers, facilities, and members. They will coordinate care across the healthcare continuum, including member outreach, provide support for alternative care options, and assess discharge readiness for members transitioning from post‑acute care to a lower level of care.
Responsibilities & Duties
Perform prospective, concurrent, and retrospective medical necessity reviews of post‑acute care services.
Ensure appropriate care setting and length of stay.
Manage appeal requests from providers, facilities, and members.
Coordinate care across the healthcare continuum, including member outreach and discharge planning.
Support alternate care options where post‑acute care is not appropriate.
Assess discharge readiness for transition to lower level of care.
Qualifications
Bachelor’s degree in Nursing, Allied Health, Business, or related field preferred.
2 to 4 years of clinical experience, including post‑acute care, home care, acute patient care, discharge planning, case management, utilization review, or caring for the aging population.
Demonstrated clinical knowledge and experience in patient care and healthcare delivery processes.
Minimum of 1 year experience in a health insurance plan or managed care environment preferred.
Registered Nurse (RN) with a current, unrestricted Michigan nursing license required.
Preferred Skills & Experience
Understanding of Medicare requirements for skilled vs. non‑skilled services in post‑acute care and home settings.
Certification in Case Management.
Experience managing patients with compromised airways requiring skilled services.
Experience with goal planning and interventions for patients recovering from unplanned or prolonged hospital admissions (e.g., stroke, hip/femur fractures, sepsis, ventilator dependency).
Additional Information Seniority level: Mid‑Senior level
Employment type: Full‑time
Industries: IT Services and IT Consulting
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Location Detroit, MI
Overview We are seeking an experienced Registered Nurse to join our team as a Utilization Management Nurse focusing on Medicare Advantage Post‑Acute Care. The nurse will use established medical policies and guidelines to perform prospective, concurrent, and retrospective medical necessity reviews of post‑acute care services, ensuring appropriate care setting, length of stay, and managing appeal requests initiated by providers, facilities, and members. They will coordinate care across the healthcare continuum, including member outreach, provide support for alternative care options, and assess discharge readiness for members transitioning from post‑acute care to a lower level of care.
Responsibilities & Duties
Perform prospective, concurrent, and retrospective medical necessity reviews of post‑acute care services.
Ensure appropriate care setting and length of stay.
Manage appeal requests from providers, facilities, and members.
Coordinate care across the healthcare continuum, including member outreach and discharge planning.
Support alternate care options where post‑acute care is not appropriate.
Assess discharge readiness for transition to lower level of care.
Qualifications
Bachelor’s degree in Nursing, Allied Health, Business, or related field preferred.
2 to 4 years of clinical experience, including post‑acute care, home care, acute patient care, discharge planning, case management, utilization review, or caring for the aging population.
Demonstrated clinical knowledge and experience in patient care and healthcare delivery processes.
Minimum of 1 year experience in a health insurance plan or managed care environment preferred.
Registered Nurse (RN) with a current, unrestricted Michigan nursing license required.
Preferred Skills & Experience
Understanding of Medicare requirements for skilled vs. non‑skilled services in post‑acute care and home settings.
Certification in Case Management.
Experience managing patients with compromised airways requiring skilled services.
Experience with goal planning and interventions for patients recovering from unplanned or prolonged hospital admissions (e.g., stroke, hip/femur fractures, sepsis, ventilator dependency).
Additional Information Seniority level: Mid‑Senior level
Employment type: Full‑time
Industries: IT Services and IT Consulting
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