- 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
- Molina Healthcare (Warren, MI)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... DESCRIPTION** **Job Summary** Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level… 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 (Warren, 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
- 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 (Warren, 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
- 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
- Corewell Health (Troy, MI)
- …patients. + Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). + ... 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
- Molina Healthcare (Warren, 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
- Tenet Healthcare (Detroit, MI)
- …benefit coverage and general concerns regarding policies and procedures. Maintains necessary utilization review files for all patients in the hospital. Validates ... appropriate provider. Performs input into various databases as appropriate for utilization management, LOS management and Denial Management activities. Audits data… 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
- Behavioral Center of Michigan (Warren, MI)
- …records for discharge/transfer. Makes appropriate copies for various departments (Nursing, Utilization Review , Billing, and Partial Hospitalization Program). + ... and compiles records for the unit. Upholds system and organization in the nurse station, giving assistance to the assigned clinical staff in the unit. Performs… more
- Tenet Healthcare (Detroit, MI)
- …services, including hospital-wide decisions regarding direct admits, transfers, pre-admission review , as well as emergency and other intra-departmental admissions. ... services according to knowledge of hospital bed capacity and utilization , availability of required clinical services, as well as...license. 3. Three to five years experience as a nurse in a patient care setting. 4. Preferably experience… more
- Tenet Healthcare (Detroit, MI)
- …services, including hospital-wide decisions regarding direct admits, transfers, pre-admission review , as well as emergency and other intra-departmental admissions. ... services according to knowledge of hospital bed capacity and utilization , availability of required clinical services, as well as...RN license. 3.Three to five years experience as a nurse in a patient care setting. 4.Preferably experience with… more