- Henry Ford Health System (Detroit, MI)
- …Proficiency with computers, electronic health records (EHR), database systems, and utilization review /case management documentation systems. Knowledge of CMS, ... resources to optimize patient outcomes and promote efficient resource utilization . Key Responsibilities: Clinical Care Coordination: Conduct comprehensive patient… more
- Hope At Home Health Care (Southfield, MI)
- …in peer review and performance improvement as assigned. Participates in utilization review of medical records as assigned. Gives total patient care ... position available for an experienced Home Health Care Registered Nurse ! A RN with Mediport, PICC Line, Wound Care,...the Tri-County area (Oakland, Macomb & Wayne). A Registered Nurse administers skilled nursing care to patients on an… more
- Molina Healthcare (Sterling Heights, MI)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical… more
- Veterans Affairs, Veterans Health Administration (Detroit, MI)
- …and record relevant] patient information. Completed work should need only a general review by a registered nurse (RN) or physician (MD/DO) for appropriateness ... the patient's care. Responsibilities VA Careers - Licensed Practical Nurse : https://youtube.com/embed/Ae85IP1Oiz4Total Rewards of a Allied Health Professional Licensed… more
- Henry Ford Health System (Detroit, MI)
- …Proficiency with computers, electronic health records (EHR), database systems, and utilization review /case management documentation systems. + Knowledge of CMS, ... resources to optimize patient outcomes and promote efficient resource utilization . Key Responsibilities: Clinical Care Coordination: + Conduct comprehensive patient… more
- Corewell Health (Troy, MI)
- …Health. Full-time, Rotating Shifts GENERAL SUMMARY: Physician Assistants (PA) and Nurse Practitioners (NP) are graduates of an accredited educational program and ... parking at all of our campuses ESSENTIAL DUTIES: + Utilization of a high degree of discriminative judgement while...recognized PA program that is accredited by the Accreditation Review Commission on Education for Physician Assistants and meet… more
- Corewell Health (Dearborn, MI)
- …Free onsite parking at all of our campuses Essential Functions + Utilization of a high degree of discriminative judgement while providing medical management ... Graduate of AMA recognized PA program that is accredited by the Accreditation Review Commission on Education for Physician Assistants and meet requirements of the… more
- Molina Healthcare (Sterling Heights, MI)
- …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical… more
- Corewell Health (Royal Oak, MI)
- …patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). 2. ... experience Three to five years' experience in care management, utilization review , home care and/or discharge planning...., home care and/or discharge planning. Preferred + Registered Nurse (RN) - State of Michigan License Upon Hire… more
- Tenet Healthcare (Detroit, MI)
- …goals and objectives that support overall strategic plans of the Case Management and Utilization Review strategy · Lead Group hospital Case Management and ... Utilization Review operations for cost-effective and clinically...business planning and project management experience preferred. Required: Registered Nurse or LCSW/LMSW license. Must be currently licensed, certified,… more
- Molina Healthcare (Sterling Heights, MI)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
- Integra Partners (Troy, MI)
- …do whatever it takes to get things done. PREFERRED SKILLS: + Certification in Utilization Review or Case Management + Experience with health insurance operations ... Integra Partners is seeking an experienced nurse educator to join our Operations Training &...team as an Operations UM Training Specialist, specializing in Utilization Management (UM) processes. The ideal candidate will have… more
- Corewell Health (Royal Oak, MI)
- …and implementation performance evaluations, OPPE/FPPE, etc. Represents APPs to outside review services such as Joint Commission, American College of Surgeons etc. ... reviewing billing practices and monitoring metrics such as reimbursement, productivity, and utilization . + Act as central oversight for CE/CME policy including … more
- Trinity Health (Livonia, MI)
- …specialists (CDS) to enhance clinical and coding skill sets and optimal utilization of the 3M CDI software. Responsible for scheduling and work assignments ... direct reports perform clinical validation as part of the review process and remain current on CDI strategies. Maintains...Must possess one of the below: + Current Registered Nurse (RN) License + Registered Health Information Administrator (RHIA)… more
- AmeriHealth Caritas (Southfield, MI)
- …plan of care, referrals, and evaluation of the effectiveness of the plan. + Review medication list and educate Members with pharmacy needs, and counsel on side ... ACFC electronic care management platforms where applicable. + Monitor appropriate utilization and coordinate services with other payer sources, make appropriate… more
- AmeriHealth Caritas (Southfield, MI)
- …plan of care, referrals, and evaluation of the effectiveness of the plan + Review medication list and educate Members with pharmacy needs, and counsel on side ... ACFC electronic care management platforms where applicable + Monitor appropriate utilization and coordinate services with other payer sources, make appropriate… more
- Corewell Health (Troy, MI)
- …join our team at Corewell Health. GENERAL SUMMARY: Physician Assistants (PA) and Nurse Practitioners (NP) are graduates of an accredited educational program and are ... their own DEA number and signature. ESSENTIAL DUTIES: + Utilization of a high degree of discriminative judgement while...recognized PA program that is accredited by the Accreditation Review Commission on Education for Physician Assistants and meet… more
