- Humana (Lansing, MI)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Lansing, MI)
- …a part of our caring community and help us put health first** The RN, Utilization Management (UM) Nurse 2 utilizes clinical nursing skills to support ... in the state of Michigan. + One (1) year of previous experience in utilization management /LTSS service authorization. + Two (2) years prior clinical experience,… more
- McLaren Health Care (Yale, MI)
- …barriers to D/C). 4. Identifies unsigned level of care (LOC) orders; communicates with utilization management nurse and obtains orders from providers. 5. ... **Three years of acute hospital care experience** _Preferred:_ + Experience in utilization management /case management , critical care, or patient… more
- CVS Health (Lansing, MI)
- …experience working within the mental health system. + Previous experience with utilization management . + Ability to collaborate with various internal ... clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Conduct clinical reviews for adult… more
- CVS Health (Lansing, MI)
- …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years post… more
- Henry Ford Health System (Troy, MI)
- …manager to provide administrative, operational, and organizational support for the Utilization Management teams. PRINCIPLE DUTIES AND RESPONSIBILITIES: + ... accreditation by NCQA and compliance with CMS and privacy policies. + Provides Utilization Management staff support and liaison support to committees, including… more
- Henry Ford Health System (Warren, MI)
- …required. + Bachelor of Science Nursing required OR four (4) years Case Management / Appeal/ Utilization Management experience in lieu of bachelor's degree. ... Under minimal supervision, reviews and screens the appropriateness of services, the utilization of hospital resources and the quality of patient care rendered.… more
- Corewell Health (Grand Rapids, MI)
- …nursing and or case management /managed care or related field Preferred + Registered Nurse (RN) - State of Michigan Upon Hire required + Basic Life Support (BLS) ... hospital in the state of Michigan. Manage all components of referral management , admission waiting list, insurance prior authorizations, continuous stay reviews and… more
- Sharecare (Lansing, MI)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- Tenet Healthcare (Detroit, MI)
- …national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention. Transition ... Registered Nurse (RN) - Case Manager - 2506003285 Description...q) and other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management : Balances clinical and financial requirements… 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
- Veterans Affairs, Veterans Health Administration (Ann Arbor, MI)
- …The LTC Charles S. Kettles VA Medical Center is seeking a Part-Time Registered Nurse (RN) for the CLC, aligned under Patient Care Services, located in Ann Arbor, ... education and coaching on wellness, disease prevention, and chronic care management . Assists in directing the provision of nursing education, orientation,… more
- Veterans Affairs, Veterans Health Administration (Iron Mountain, MI)
- …for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care. Responsibilities ... and initiatives as well as customer service programs. The Staff Registered Nurse (RN) is responsible for providing competent, evidence-based outpatient care to… more
- Henry Ford Health System (Detroit, MI)
- The Certified Registered Nurse Anesthetist (CRNA) Manager is a Certified Registered Nurse Anesthetist who ensures the delivery of safe anesthetic patient care in ... hospital/system leaders to develop a quality practice setting that supports professional nurse anesthesia practice and quality patient care. The CRNA Manager is… more
- University of Michigan (Ann Arbor, MI)
- …the daily patient transmissions of physiological data, educating patients on symptom management , triaging patient virtually. The Registered Nurse will also ... REGISTERED NURSE (PACS- Patient Monitoring at Home Program) Apply...PCP, Specialist and plan of care to reduce ED utilization and acute care hospitalizations + Monitor daily transmissions… more
- Molina Healthcare (Sterling Heights, MI)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... **JOB DESCRIPTION** **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for… more
- Molina Healthcare (Detroit, 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
- Pine Rest Christian Mental Health Services (Grand Rapids, MI)
- …treatment time frames, as treatment is 90-180 days. What Will You Do? As a Graduate Nurse (RN) at Pine Rest, you'll be part of tight-knit team that believes in the ... healing power of your expertise and compassion. A Graduate Nurse is responsible and accountable to perform the nursing process as a basis for patient care. Graduate … more
- Humana (Lansing, MI)
- …degree in a related field + Health Plan experience + Previous experience in utilization management , discharge planning and/or home health or rehab + Bilingual is ... us put health first** The NICU Care Manager, Telephonic Nurse 2, in a telephonic environment, assesses and evaluates...and wellbeing of members. The NICU Care Manager, Telephonic Nurse 2 work assignments are varied and frequently require… more
- ChenMed (Detroit, MI)
- …expanding and we need great people to join our team. The Registered Nurse 1, Care Line, is responsible for providing telephonic triage directional patient care ... client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. Providing on-call coverage, the… more