- Novo Nordisk Inc. (Detroit, MI)
- …include key opinion leaders (KOL's), academic institutions, physicians, nurse practitioners, cardiovascular educators, pharmacists, blood bank staff, organized ... policies, legal, regulatory, and compliance requirements Ensures effective administrative management of regional business as well as operational budgets Maintains… more
- 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
- CVS Health (Lansing, MI)
- …Monday through Friday 8:30-5pm EST. No weekends or holidays. + 1+ years of utilization review/ utilization management required. + 3+ years of behavioral ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable… more
- Humana (Lansing, MI)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- McLaren Health Care (Pontiac, MI)
- …_and_ maintenance of continuing education requirements _Preferred:_ + Bachelor's degree in nursing + Experience in utilization management /case management ... **Position Summary:** Responsible for Utilization and Care Management services to...assigned. #LI-KH1 _Required_ + State licensure as a Registered Nurse (RN) + Bachelor's degree in nursing … more
- Humana (Lansing, MI)
- …a part of our caring community and help us put health first** The Compliance Nurse 2 reviews utilization management activities and documentation to ensure ... prevent and detect fraud, waste, and abuse. The Compliance Nurse 2 work assignments are varied and frequently require...one, (1), year of experience auditing and/or performing case management or utilization management chart… more
- CVS Health (Lansing, MI)
- …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and knowledge in ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- Integra Partners (Troy, MI)
- …individual situation or the local delivery system rendering the criteria inappropriate, the Utilization Management Nurse will route the case to the ... seeking a full-time Utilization Review Medical Director to support our Utilization Management team. This is a salaried, 40+ hour per week position expected… more
- Tenet Healthcare (Detroit, MI)
- …standards. The individual in this position has overall responsibility for hospital utilization management , transition management and operational ... · Lead the implementation and oversight of the hospital Utilization Management Plan using data to drive... management leadership experience, business planning and project management experience preferred. Required: Registered Nurse or… more
- Tenet Healthcare (Detroit, MI)
- …national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention. Transition ... and other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES : Utilization Management : Balances clinical and financial requirements... Management , and other topics specific to case management . Job : Nursing Primary Location :… more
- Corewell Health (Royal Oak, MI)
- …of care and cost effectiveness through the integration and functions of utilization management , and/or care coordination, discharge planning, and appropriate ... managing a case load of patients that includes facilitating utilization management , and/or care coordination during the...Required Bachelor's Degree Graduate of an accredited school of nursing . + Preferred Will consider non-BSN RN if actively… 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
- Molina Healthcare (Sterling Heights, MI)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Integra Partners (Troy, MI)
- …years of experience in clinical nursing , with at least 4 years in Utilization Management . + 2+ Years of experience in Training & Development, healthcare ... Training & Development team as an Operations UM Training Specialist, specializing in Utilization Management (UM) processes. The ideal candidate will have a… more
- McLaren Health Care (Petoskey, MI)
- …between patients, colleagues and community. 5. Performs concurrent and retrospective utilization management -related activities and functions to ensure that ... * Bachelor's degree in coding/medical records/billing or UM * Two years of case management or utilization review experience * Three years of recent experience… more
- McLaren Health Care (Petoskey, MI)
- …barriers to D/C). 4. Identifies unsigned level of care (LOC) orders; communicates with utilization management nurse and obtains orders from providers. 5. ... and maintenance of continuing education requirements **Preferred:** * Experience in utilization management /case management , critical care, or patient… more
- Evolent (Lansing, MI)
- …Doing:** 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...**Qualifications:** + Current, unrestricted state licensure as a Registered Nurse + Associate or Bachelors in Nursing … more
- Henry Ford Health System (Detroit, MI)
- …five years. Experience: + Minimum of three years of recent acute care nursing experience. + Prior case management experience is highly preferred. Certifications: ... Proficiency with computers, electronic health records (EHR), database systems, and utilization review/case management documentation systems. + Knowledge of CMS,… more
- Corewell Health (Grand Rapids, MI)
- …with external partners and reports directly to the Senior Director of Utilization Management . Essential Functions Strategic Leadership & Program Oversight: + ... with leaders across the enterprise (eg, Medical Directors, Quality Improvement, Utilization Management , Care Management , Medicare Product Development,… more
