Seeking a Michigan Licensed Utilization Review Nurse, the contingent remote position will conduct Nursing Facility Level of Care reviews and Home Help quality assessments for Michigan Medicaid programs while maintaining a adaptable schedule of at least 4-8 hours per week.
Key responsibilities Perform utilization review activities in accordance with clinical guidelines and regulatory standards Conduct telephonic Nursing Facility Level of Care reviews and virtual Home Help assessments for beneficiaries Document review findings accurately within secure electronic systems and participate in administrative hearings as necessary Required qualifications Active, unrestricted Michigan Registered Nurse (RN) license Experience in Long-Term Care/LTSS and Utilization Review/Utilization Management 3-5 years of combined experience in relevant fields Bachelor's degree in nursing preferred, with equivalent experience considered Strong knowledge of Medicaid regulations and long-term care determinations