Michigan Licensed Utilization Review Nurse
Job Summary
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 flexible 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
Complete Job Description
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