- Humana (Lansing, MI)
- …part of our caring community and help us put health first** The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and ... receives guidance where needed. Follows established guidelines and procedures. The SNF Utilization Management Nurse uses clinical knowledge, communication… more
- CVS Health (Lansing, MI)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in EST and CST zones.… more
- CVS Health (Lansing, MI)
- …Must be willing and able to work Monday through Friday, 8:00am to 5:00pm. Utilization management is a 24/7 operation. Work schedules will include weekend/holiday ... zone + 3+ years of experience as a Registered Nurse + 3+ years of clinical experience required +...+ Managed Care experience + Discharge planning experience + Utilization Management experience **Education** Associates Degree or… more
- Humana (Lansing, MI)
- …a part of our caring community and help us put health first** The Utilization Management (UM) Director, Clinical Strategy and Practice for Medicaid builds ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director, Clinical Strategy and Practice for… more
- Zurich NA (Lansing, MI)
- …+ Experience in development and implementation of cost containment programs + Case management , utilization review, catastrophic or disability experience + 5 or ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… more
- Evolent (Lansing, MI)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- Sharecare (Lansing, MI)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... the participants and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised… more
- Highmark Health (Lansing, MI)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Evolent (Lansing, MI)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- United Therapeutics (Lansing, MI)
- …for which transplant is not currently an option. Who you are You are experienced nurse and an expert in all things PAH. You love providing mentorship, coaching and ... make a difference. The Regional Field Director, RNS Program Management serves as a director of all clinical field...+ Plan, collaborate, create and produce the yearly Clinical Nurse Summit meeting for HCPS across the United States… more
- Humana (Lansing, MI)
- …**Key Functions:** **Strategic Planning and Implementation:** + Develop and implement utilization management strategies that align with organizational goals. + ... care. **Cost Containment:** + Identify opportunities for cost savings through effective utilization management practices. + Monitor and analyze utilization … more
- McLaren Health Care (Lansing, MI)
- …Manager, the Certified Lactation Consultant independently provides consultations to management for routine and complex breastfeeding situations during the perinatal ... in the community. 1. Provides clinical and/or professional consultations regarding management of lactation dysfunction collaboratively to nursing, medical, and other… more
- McLaren Health Care (Lansing, MI)
- …Assists Manager of Patient Care Services with 24-hour accountability for the management of multiple patient care units/functions. In this capacity, will accomplish ... the mission and vision of McLaren Greater Lansing through effective utilization of all resources, constantly striving to increase quality patient care and maintain a… more
- McLaren Health Care (Grand Ledge, MI)
- **Position Summary:** Has responsibility for 24-hour accountability for the management of assigned patient care unit(s)/function(s). In this capacity, will ... accomplish the mission and vision of McLaren Greater Lansing through effective utilization of all resources, constantly striving to increase quality patient care and… more
- Highmark Health (Lansing, MI)
- … **SKILLS** + Deep Clincal Expertise -extensive knowledge of clinical, quality, care, utilization , high-cost claim, and population health management . Must be a ... in Business or Clinical field **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse (RN) or Pharmacist (Pharm D) or Physician Assistant (PA) **Preferred** +… more