Highlights
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. Two (2) to four (4) years of clinical experience which may include acute patient care, discharge planning, case management, and utilization review, etc.
Numbers & Facts
| Location | Detroit, MI (Remote) |
| Industry | Staffing/Employment Agencies |
| Company Size | 100 to 499 employees |
| Year Founded | 1998 |
| Website | http://www.kyyba.com/ |
Description
Location is remote, candidate will be able to perform role offsite.
- 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.
- May establish care plans and coordinate care through the health care continuum including member outreach assessments.
- Bachelor's degree in nursing, allied health, business, or related field preferred.
- Two (2) to four (4) years of clinical experience which may include acute patient care, discharge planning, case management, and utilization review, etc.
- Demonstrated clinical knowledge and experience relative to patient care and health care delivery processes.
- One (1) year health insurance plan experience or managed care environment preferred.
- Registered Nurse with current unrestricted Michigan Registered Nurse license required.
- Certification in Case Management may be preferred based upon designated department assignment.
Requested criteria:
- Above average computer skills (Microsoft office).
- Clinical experience in ICU, ER, or medical surgical unit preferred.
- Prefer utilization management experience.
- Resource will be able to perform this role offsite.
- May be required to come into the office for meetings and training.
About Company
Kyyba group of companies are privately held and specialize in staff augmentation, application software and project solutions. In operation for more than 15 years, we have earned an enviable track record and reputation within all the industries we serve. Our unique processes and maturity enables us to understand the needs of the business organizations and provide business solutions that match the real and compelling needs of our customers.
Headquartered in Michigan, Kyyba has multiple office locations and we serve local, regional and national client base consisting of Fortune 500 and middle market companies. Kyyba extends the above solutions and services to a broad spectrum of industry verticals ranging from automotive, insurance, technology, financial, transportation, government and so on.
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