- McLaren Health Care (Detroit, MI)
- **Department: Utilization Management ** **Daily Work Times: 7:00am-3:30pm** **Shift: Days** **Scheduled Bi-Weekly Hours: 40** **Position Summary:** Responsible ... as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate… more
- Elevance Health (Dearborn, MI)
- **Clinical Operations Medical Director** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management ** **$20,000 Sign On Bonus** ... members and providers. **Job Summary:** + Perform physician-level case review , following initial nurse review ,...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
- Universal Health Services (Dearborn, MI)
- …related experience in psychiatric or substance abuse treatment required. Hospital utilization review / utilization management experience preferred. ... in social work, counseling or a Michigan licensed Registered Nurse is required. + Full licensure in the State...managed health care process, medical terminology, experience in case management , discharge planning, and/or utilization review… more
- Henry Ford Health System (Detroit, MI)
- …Team Structure:Benefit from our new dyad Social Work/RN Case Manager model and remote utilization review setup, allowing you to excel in your profession. + ... **NEWLY ENHANCED PAY RATES** Inpatient Case Management Days (6am to 6pm); Every 5th Weekend...and dynamic environment? Join our team as a Registered Nurse (RN) Case Manager! Who We're Looking For: Passionate,… more
- Elevance Health (Dearborn, MI)
- …**How you will make an impact:** + Develops, maintains and enhances the claims review process. + Assists management with developing unit goals, policies and ... ** Nurse Audit Lead** **Supports the Carelon Payment Integrity...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through… more
- Trinity Health (Ann Arbor, MI)
- **Employment Type:** Part time **Shift:** **Description:** Exceptional opportunity for a **Registered Nurse ** to support our vision and serve with us as a ... variety of backgrounds because diversity makes us stronger. The RN Registered Nurse Case Manager assumes overall accountability for patients' discharge plans while… more
- Ciena Healthcare (Novi, MI)
- …hard-working team that values communication and strong teamwork abilities. Responsibilities: The Care Management Nurse , MDS Nurse works the RAI process and ... Are you an experienced nurse who wants to remain clinically involved in...PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management… more
- Trinity Health (Ann Arbor, MI)
- …Type:** Part time **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 ... + Free onsite parking at all of our campuses ESSENTIAL DUTIES: + Utilization of a high degree of discriminative judgement while providing medical management… more
- Fresenius Medical Center (Detroit, MI)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Corewell Health (Royal Oak, MI)
- …discharge planning of all hospitalized patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; and/or ... relevant experience Three to five years' experience in care management , utilization review , home care..., home care and/or discharge planning. Preferred + Registered Nurse (RN) - State of Michigan License Upon Hire… more
- Trinity Health (Livonia, MI)
- …version of InterQual in Cerner Care Management . o Follows the hospital Utilization Review Plan to ensure effective and efficient use of hospital services. ... time **Shift:** **Description:** RHIT Does not require RN The Utilization Review (UR) Coordinator I colleague is...RESPONSIBILITIES MAY INCLUDE 1. Provides leadership and expertise for utilization management processes. 2. Manages the DNFB… more
- Tenet Healthcare (Detroit, MI)
- …coverage, and appropriate provider. Performs input into various databases as appropriate for utilization management , LOS management and Denial Management ... Care Management Technician-SG - 2406000760 Description : Summary Description...and general concerns regarding policies and procedures. Maintains necessary utilization review files for all patients in… more
- Trinity Health (Farmington Hills, MI)
- …rejection, denial and appeal activities with Regional Health Ministries (RHM) based Utilization Review /Case Management departments; + Reviews and understands ... **MINIMUM QUALIFICATIONS** Must possess a demonstrated knowledge of denial management functions. Registered Nurse and a graduate...nursing experience, to include at least three (3) f utilization review /case management , managed care… more
- Trinity Health (Farmington Hills, MI)
- …Coordinates rejection, denial and appeal activities with Ministry Organization (MO) based Utilization Review /Case Management departments; + Reviews and ... **MINIMUM QUALIFICATIONS** Must possess a demonstrated knowledge of denial management functions. Registered Nurse and a graduate...of nursing experience, to include two (2) years of utilization review /case management , managed care… more
- Ciena Healthcare (Ann Arbor, MI)
- …assessments and care plan coordination for guests. The MDS Coordinator supervises the Care Management Nurse , MDS Nurse . At Ciena Healthcare, we take care ... Are you an experienced MDS nurse interested in the next step? The MDS...PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management… more
- Trinity Health (Livonia, MI)
- …(CDI) activities for the Health Ministries (HM) in their defined region and day-to-day management of the CDI programs. Works with Director, CDI to ensure the program ... to enhance clinical and coding skill sets and optimal utilization of 3M CDI software. Analyzes data to determine...direct reports perform clinical validation as part of the review process and remain current on CDI strategies. Uses… more
- Corewell Health (Royal Oak, MI)
- …stakeholders. Also, ensures continuity of and coordination of services with appropriate utilization of resources. + Responsible for stakeholder management across ... followed. This may be done in coordination with Risk Management . + Patient Rights Champion: Receive, Review ,...(OPTIONAL) Qualifications Required + Bachelor's Degree BSN + LIC-Registered Nurse (RN) - STATE_MI State of Michigan + 5… more
- Trinity Health (Livonia, MI)
- …order modification, D/C and cancel orders as directed. + Printer and Fax machine utilization and trouble shooting + Makes a manual requisition for patient orders for ... Registered Nurse approval during emergencies, codes and downtime. + Maintains...access, retrieve and print reports from Quest/Vista. + Obtain, review and correct errors per error report(s) or upon… more
- Henry Ford Health System (Wyandotte, MI)
- …group therapy experience, safety planning, psychiatric assessment, COPE and DWIHN knowledge, utilization review . GENERAL SUMMARY: The Case Manager is a member ... who have experienced a critical event or diagnosis that requires management strategies to optimize health outcomes along the care continuum. EDUCATION/EXPERIENCE… more