Utilization Management Medicare Advantage Post-Acute Care RN Training will be onsite for first 2 weeks, then fully remote. Summary: Use established medical policy and guidelines to perform prospective, concurrent, and retrospective medical necessity review of post-acute care services to ensure medical necessity for appropriate setting, appropriate length of stay, including appeal requests initiated by providers, facilities and members. Will coordinate care through the health care continuum including member outreach. Provides support and alternative care support for member not appropriate for post-acute care service as well formulate discharge readiness for members transitioning from a post-acute care setting to a lower level of care. Required Experience: Bachelor s degree in nursing, allied health, business, or related field preferred. Two (2) to four (4) years of clinical experience which may include post-acute care, home care, acute patient care, discharge planning, case management, and utilization review, and caring for aging population in the home or post-acute care setting, etc. Demonstrated clinical knowledge and experience relative to patient care and health care delivery processes. One (1) year health insurance plan experience or managed care environment preferred. Registered Nurse with current unrestricted Michigan Registered Nurse license required. Preferred: Understanding Medicare Requirements for skilled vs non-skilled services in post-acute care and home setting. Certification in Case Management. Experience with management of patients with compromised airways requiring skilled services. Experience with goals planning and intervention for patients recovering after unplanned or prolonged hospital admission including but not limited to stroke, hip and femur fractures with surgical intervention after a fall, sepsis, ventilator dependency, sever change in functional ability