- Utilize established medical policy and guidelines to conduct prospective, concurrent, and retrospective medical necessity reviews of post-acute care services to ensure appropriate setting and length of stay, handling appeal requests from providers, facilities, and members.
- Coordinate care across the health care continuum, including member outreach.
- Offer support and alternative care solutions for members not suited for post-acute care, as well as prepare discharge readiness for members transitioning to a lower level of care.
- Preferably possess a Bachelor's degree in nursing, allied health, business, or related field. Have 2 to 4 years of clinical experience, including post-acute care, home care, acute patient care, discharge planning, case management, and utilization review.
- Show demonstrated clinical knowledge and experience regarding patient care and healthcare delivery processes.
- Desirable to have at least 1 year of experience in a health insurance plan or managed care environment. Must hold a current unrestricted Michigan Registered Nurse license.
- Additional skills that are beneficial but not mandatory: understanding Medicare Requirements for skilled vs non-skilled services in post-acute care and home settings, certification in Case Management, and experience with managing patients with compromised airways, among others.
- Major Medical Coverage, including dental and vision
- 401k
- Term life insurance
- Short-term and long-term disability coverage
- Pre-paid legal plan and Identity theft protection
- Medical and dependent FSA, HSA
- Paid time off and holidays
- Opportunities for career advancement
- Recognized as an INC 5000 company for 10 consecutive years
- Featured as one of Michigan Economic Bright Spots by Corp
- Ranked among Crain's Detroit Business Top Staffing Service Companies
- Received TechServe Alliance Excellence Award for IT and Engineering Staffing & Solutions
- Winner of Best of MichBusiness in HR Wizards & Partnerships
- Named in Metro Detroit Elite Category for Recruitment, Selection & Orientation by 101 Best & Brightest
- Honored among the 101 Best & Brightest Companies to Work for in Michigan
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Mi-Medicare Advantage Post-Acute Care RN - Detroit, United States - KYYBA
Description
Medicare Advantage Post-Acute Care Registered Nurse:
About the Position and Company:
This position as a Medicare Advantage Post-Acute Care RN at our company presents a dynamic opportunity to make a significant impact on patient care outcomes and healthcare delivery processes. You will be part of a team dedicated to ensuring the highest quality of care to our members.
Now, let's talk about Kyyba:
Kyyba, founded in 1998 and based in Farmington Hills, MI, is a global organization known for providing premium resources and exceptional recruiting services. Our commitment to assisting businesses in adapting to technological advancements and organizational changes sets us apart in the industry.
At Kyyba, we prioritize the well-being of our employees and their families. Our work culture reflects our core values, emphasizing value, passion, excellence, empowerment, and happiness, fostering a vibrant and productive environment. We offer comprehensive benefits, a balanced compensation structure, and ample opportunities for career growth and development.
Kyyba operates as an Equal Opportunity Employer.
Employee Benefits:
Noteworthy Awards:
Working hours: Monday - Friday from 8:30 am to 5:00 pm.
