The nurse will perform utilization reviews and virtual Home Help assessments for Michigan Medicaid beneficiaries to determine eligibility and medical necessity. They will also document findings, communicate with providers, and participate in administrative hearings as needed.
Review treatment requests and medical records to ensure medical necessity and compliance with workers' compensation guidelines. Prepare clear, objective, and timely review determinations while maintaining confidentiality and regulatory standards.
Conduct objective, evidence-based peer reviews of clinical cases to determine medical necessity and quality of care. Ensure all decisions are fair, unbiased, and submitted in a timely manner using provided IT systems.
Conduct objective, evidence-based peer reviews of clinical cases to determine medical necessity and quality of care. Ensure all decisions are fair, unbiased, and submitted in a timely manner using provided IT systems.
Conduct objective, evidence-based peer reviews of clinical cases to evaluate medical necessity and quality of care. Ensure all final determinations are fair, unbiased, and aligned with current clinical standards.
Conduct objective, evidence-based peer reviews of clinical cases to determine medical necessity and quality of care. Ensure all decisions are fair, unbiased, and submitted in a timely manner using the provided IT systems.
