RN Compliance Analyst

We are seeking an RN Clinical Review Analyst, 100% Remote in Michigan, with an active RN Michigan license. This is with a healthcare insurance company.

Responsibilities:

• Providing clinical and educational support assessments
• Clinical analysis
• Coordination of the quality and training management program
• Assisting in the divisional accreditation process
• Conducting/assisting with internal and external audits

Skills:

• Five yrs in health-related fields required.
• Three yrs with Care Management and/or Utilization Management.
• Knowledge of utilization management and InterQual or MCG
• Knowledge CMS, NCQA, PA60, HIPPA
• Ability to use clinical assessments and interventions.

Technology:

• Proficient in Share point, Care Advance, Excel, Word, Teams
• Use of dual monitors
• Typing and use of multiple systems and applications
• Virtual Desktop, Care Advance, Member Records portal

Education/Cert/License:

• Nursing Diploma or AD in Nursing required. BSN preferred.
• RN with current unrestricted Michigan license
• CM certification preferred.

Why work with us? We are a woman-owned company that values your ideas, encourages your growth, and always has your back. When you work with us you'll have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. Apply today! We are an EOE, all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. https://www.optechus.com/eeo_self_identification/