- 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 ... in med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in EST zones.… more
- Baylor Scott & White Health (Lansing, MI)
- **LOCATION:** Remote **SPECIALTY/DEPARTMENT:** Care Management : Case Management Utilization Management Appeals or grievances **SHIFT/SCHEDULE:** ... on position type and/or level **Job Summary** A Registered Nurse in Nursing Professional Development Generalist role...IN ONE OR MORE OF THE FOLLOWING SPECIALITIES:** **Case Management ** ** Utilization Management ** **Appeals or… more
- Humana (Lansing, MI)
- …Social Worker (LSW). + 5+ years of clinical experience, to include a combination of Utilization Management Case Management , and Managed Care. + 2+ years of ... part of our caring community and help us put health first** The Care Management Liaison shall have responsibility for coordinating with and bridging gaps between the… more
- Evolent (Lansing, MI)
- …As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts...or Oregon License Required** + Associate or Bachelors in Nursing (Must be a Registered Nurse ) -… more
- Humana (Lansing, MI)
- …course of action. **Key Functions:** + Serves as a liaison between Humana utilization management (UM) operations, Humana's Risk and Compliance lines of defense, ... regarding prior authorization reviews, prepayment retrospective reviews, and any additional utilization management functions. + Develop and implement … more
- CVS Health (Lansing, MI)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... using a keyboard **Preferred Qualifications** - 1+ years' Case Management experience or discharge planning, nurse navigator...lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC recognized accreditation… more
- CVS Health (Lansing, MI)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... in **Specialty Pharmacy or Oncology.** **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Humana (Lansing, MI)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- Highmark Health (Lansing, MI)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of… more
- McLaren Health Care (Lansing, MI)
- …14. High degree of interpersonal skills to effectively communicate with physicians, nursing , families/patients, utilization management and internal and ... knowledge of insurance benefits and coverage guidelines to maximize appropriate utilization of resources. 13. Documents in the EMR: assessment, plans, interventions,… more
- Sedgwick (Lansing, MI)
- …satisfaction; to ensure efficient, cost effective, and high quality delivery of case management and utilization review services to clients for multiple business ... lines; and to provide expertise in client specific case management and utilization review requirements and ensure...territory of the United States required. Certification in case management required. Bachelor's degree in nursing (BSN)… more
- Sharecare (Lansing, MI)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse...Hours are on Central Standard Time. _ A compact nursing license is required for this position_ **Essential Job… more
- United Therapeutics (Lansing, MI)
- …and development of clinical content + Demonstrated high competency in clinical management , conversations, patient management , and clinical/ nursing processes ... currently an option. Who you are You are experienced nurse and an expert in all things PAH. You...maintain key external relationships within regions + Strong project management skills + Demonstrates expertise in nursing /… more
- McLaren Health Care (Lansing, MI)
- …in the community. 1. Provides clinical and/or professional consultations regarding management of lactation dysfunction collaboratively to nursing , medical, and ... or Licensed Practical Nurse program. * One year of clinical experience in prenatal nursing . * Licensed Registered Nurse or Practical Nurse by State of… 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
- 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 ... and other stakeholders. **EDUCATION** **Required** + Bachelor's degree in Nursing , Pharmacist, Physician Assistant or Clinical field **Substitutions** + None… more
- Merck (Lansing, MI)
- …Execute engagement strategies that align with market needs, enhance appropriate product utilization , and support the company's HIV portfolio. + Collaborate with AHPs ... community educator identification to ensure alignment with corporate objectives. **Account Management & Business Performance** + Manage key accounts across Ryan… more
- CVS Health (Lansing, MI)
- …it all with heart, each and every day. **Position Summary** Population Health management is built on a detailed understanding of the distribution of social, ... of Michigan. **Core responsibilities** + Responsible for all population health management components. + Oversee the strategic design, implementation, and evaluation… more
- State of Michigan (Lansing, MI)
- …communication, health policy or a public health-related field such as nursing , epidemiology, health education, health economics, dietetics/nutrition management , ... communication, health policy or a public health-related field such as nursing , epidemiology, health education, health economics, dietetics/nutrition management ,… more