- McLaren Health Care (Port Huron, MI)
- …as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate ... for timeliness, appropriateness and completeness as pertains to the utilization management process including level of care,...and directed. **Qualifications:** Required ⦁ State licensure as a registered nurse (RN) ⦁ Bachelor's degree in… more
- Henry Ford Health System (Warren, MI)
- …screening criteria and critical thinking to maximize reimbursement. EDUCATION/EXPERIENCE REQUIRED: + Registered Nurse required. + Minimum 3-5 years of clinical ... required. + Bachelor of Science Nursing required OR four (4) years Case Management / Appeal/ Utilization Management experience in lieu of bachelor's degree.… more
- Molina Healthcare (Sterling Heights, MI)
- …chief medical officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * ... be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and...or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active… more
- Molina Healthcare (Sterling Heights, MI)
- …ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) ... modification of payment decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and member/provider inquiries/appeals. + Provides… more
- Prime Healthcare (Port Huron, MI)
- …computer skills. Preferred qualifications: 1. Healthcare professional licensure required as Registered Nurse , Licensed Clinical Social Worker (LCSW), or Licensed ... leadership and supervision to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and … more
- Molina Healthcare (Sterling Heights, MI)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active...in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management … more
- Molina Healthcare (Sterling Heights, MI)
- …internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual… more
- Molina Healthcare (Sterling Heights, MI)
- For this position we are seeking a (RN) Registered Nurse who must be licensed for the state they reside This role will be doing Utilization review for our ... to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required...or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active… more
- Molina Healthcare (Sterling Heights, MI)
- …at least 3 or more years in one or more of the following areas: utilization management , care management , care transitions, behavioral health, or equivalent ... external vendors. * Focuses on process improvement, organizational change management , program management and other processes relative...combination of relevant education and experience. * Registered Nurse (RN), Licensed Vocational … more
- Molina Healthcare (Sterling Heights, MI)
- …at least 3 or more years in one or more of the following areas: utilization management , care management , care transitions, behavioral health, or equivalent ... external vendors. + Focuses on process improvement, organizational change management , program management and other processes relative...combination of relevant education and experience. + Registered Nurse (RN), Licensed Vocational … more
- Molina Healthcare (Sterling Heights, MI)
- …and cost-effective member care. The candidate must have Medicare Appeals and/or Utilization Management knowledge. Work hours are Monday-Friday 8:00am- 5:00pm ... to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required...or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active… more
- Molina Healthcare (Sterling Heights, MI)
- For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of ... to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required...or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active… more
- McLaren Health Care (Port Huron, MI)
- …complete BSN or BS within 3 to 5 years from date of hire.) + Licensed registered nurse in the State ofMichigan. + BLS certification as Healthcare Provider. + ... **Position Summary:** Has responsibility for 24-hour accountability for the management of assigned patient care unit(s)/function(s). In this capacity, will… more
- Molina Healthcare (Sterling Heights, MI)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required Qualifications** * At ... authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more
- Molina Healthcare (Sterling Heights, MI)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more