Medicare Advantage RN Review Analyst

Title: Medicare Advantage RN Review Analyst (Exclusive opening) 
Location: Detroit, MI (Remote – must be local to Michigan)
Duration: 12+ Months
Role Type: W2 Contract Engagement
Max Pay Rate: 38/HR

SUMMARY
Responsible for the approval or rejection of claims and/or benefit interpretation. May be required to enter or reference data via PC and/or Clinical Review Team terminal. Advise customers of updates to all lines of business and how the updates will benefit the members and impact the group’s experience and utilization.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Assist specific area(s) in: deployment and operational activities and/or development, implementation, and maintenance of clinical operational processes.
• Identify and/or analyze business problems and devise procedures for solutions to problems; prepare reports and/or analyze, documenting results.
• Design, develop, modify, test, implement and maintain assigned systems, either independently or as part of a team.
• Troubleshoot problems and submit recommendations. May be required to interface with other areas, both internal and external, to resolve problems.
• Assist personnel (both external and internal) by answering questions, supplying information and training.

EDUCATION AND/OR EXPERIENCE

• Associate’s degree in nursing or RN Diploma required. Bachelor’s Degree preferred.
• Two (2) to four (4) years of clinical experience.
• Demonstrated clinical knowledge and experience relative to patient care and health care delivery processes.

CERTIFICATES, LICENSES, REGISTRATIONS

• Current unrestricted state of Michigan registered nurse license required.

*Beware of scams. S3 never asks for money during its onboarding process

Job ID: JOB-240294
Publish Date: 19 Feb 2025

Tagged as: Medicare Advantage RN Review Analyst