- 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
- CVS Health (Lansing, MI)
- …includes navigating multiple systems and keyboarding Preferred Qualifications: - Managed care/ utilization review experience preferred - Ability to multitask, ... and external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications: - Must have active,… 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
- Lincoln Financial Group (Lansing, MI)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… 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
- McLaren Health Care (Bay City, 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
- Ciena Healthcare (Westland, MI)
- …hard-working team that values communication and strong teamwork abilities. **Responsibilities:** The Care Management Nurse , MDS Nurse works the RAI process ... 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
- Ciena Healthcare (Galesburg, MI)
- …hard-working team that values communication and strong teamwork abilities. **Responsibilities** The Care Management Nurse , MDS Nurse works the RAI process ... 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 (Troy, MI)
- …join our team at Corewell Health. GENERAL SUMMARY: Physician Assistants (PA) and Nurse Practitioners (NP) are graduates of an accredited educational program and are ... + Free onsite parking at all of our campuses ESSENTIAL DUTIES: + Utilization of a high degree of discriminative judgement while providing medical management… more
- McLaren Health Care (Port Huron, MI)
- …report to Patient Care Services Manager of Nursing Support or Utilization Review /Patient Placement Coordinator. 9. Initiates continuous communication with ... bed availability in patient care departments by super census review and continuous rounding. 5. Communicates and coordinates with...and recent acute care experience + ACRN experience + Utilization Management knowledge in addition to health… 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
- Fresenius Medical Center (Jackson, MI)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Marriott (Lansing, MI)
- …with Claims department regarding case management . + Collaborate with UNM on utilization review issues. + Refer catastrophic cases in coordination with claims ... claims most likely to benefit from case management to meet jurisdictional needs. ** Utilization Review ** + Provide initial clinical review in order to… 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