Conduct objective reviews of IDR/IIDR cases involving healthcare regulatory citations and develop clear, evidence-based written recommendations. Facilitate IDR/IIDR conferences professionally while ensuring compliance with CMS and URAC standards.
The nurse will perform utilization review activities, including Nursing Facility Level of Care reviews and Home Help quality assessments for Michigan Medicaid beneficiaries. They are responsible for evaluating medical records, applying clinical criteria, and participating in administrative hearings when necessary.
Conduct objective, evidence-based peer reviews of clinical cases to evaluate medical necessity and standard of care. Make final determinations regarding quality of care and submit reviews 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 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.
