- R1 RCM (Detroit, MI)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Nurse ** , you will help our ... in this remote position. **Here's what you will experience working as a Utilization Review Nurse :** + Perform initial admission and continued stay reviews… more
- Tenet Healthcare (Detroit, MI)
- Registered Nurse Case Manager Full Time Days - 2506001582 Description : DMC Sinai-Grace Hospital is DMC’s largest hospital, offering a comprehensive heart center, ... to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patients resources and right to… more
- Molina Healthcare (Detroit, MI)
- …Practical Nurse (LPN) Program **Required Experience** + Minimum two years Utilization Review experience. + Knowledge of audit processes and applicable state ... contained in the delegation agreement. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM… more
- Molina Healthcare (Detroit, MI)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases… 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
- Trinity Health (Ann Arbor, MI)
- …time **Shift:** Day Shift **Description:** **POSITION PORPOSE** + The Registered Nurse Case Manager assumes overall accountability for patients' discharge plans ... leadership role in achieving desired clinical, financial and resource utilization outcomes. + This is achieved by coordinating care...Friday. **WHAT YOU WILL DO** + The RN Registered Nurse Case manager is responsible for conducting a focused… more
- Corewell Health (Farmington Hills, MI)
- …Health. Casual/PRN, Rotating Shift 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
- Fresenius Medical Center (Dundee, MI)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
- Molina Healthcare (Detroit, MI)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has a compact, multi-state license. This team reviews the prior ... requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference will be… more
- Trinity Health (Livonia, MI)
- …Health at Home is seeking an experienced RN remote Clinical Quality Review Specialist with ICD10 HCS-D certification which is Required. OASIS COS-C certification ... hire **Trinity Health at Home is seeking an experienced RN Clinical Quality Review Specialist for a remote position** **ICD10 HCS-D certification which is Required… more
- Corewell Health (Farmington Hills, 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 (Detroit, 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
- Trinity Health (Ann Arbor, MI)
- …managed care guidelines, best practice protocols, evidenced based care, and the utilization review processes. In partnership with the supervising physician the ... : Master's Degree in clinical nursing from an accredited Acute Care Nurse Practitioner Program with emphasis on area of certification/licensure. **NP Licensure** :… more
- University of Michigan (Ann Arbor, MI)
- …readiness, etc.) + Collaborate with the Medical Director, Lab Manager, and Nurse Supervisor to review incident reports and ensure appropriate follow-up. ... for Ambulatory Care Services, and partners with the Medical Director and the Nurse Supervisor for overall performance and management of the Ambulatory Care Unit.… 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
- Henry Ford Health System (Detroit, MI)
- …policy issues. 3. Regularly monitors and ensures compliance with annual performance review deadlines. 4. Works closely with HR and APP recruiters, develops and ... partners, and the community as needed to promote APPs practice and utilization . General Expectations 1. Maintains an environment of open communication and teamwork.… more
- Tenet Healthcare (Detroit, MI)
- …of care inclusive of the QAPI Plan. Other oversight includes: a. utilization of telehealth/telemedicine, if used. 2. Develop and maintain the Maternal Program ... higher-level of care; and d. staff competency, training and education. 5. Consistently review the perinatal care provided and ensure the Maternal QAPI Plan is… 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