- R1 RCM (Detroit, MI)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Nurse ** , you will help our ... in this remote position. **Here's what you will experience working as a Utilization Review Nurse :** + Perform initial admission and continued stay reviews… more
- McLaren Health Care (Pontiac, MI)
- **Position Summary:** Responsible for Utilization and Care Management services to the Emergency Center. Advises providers to determine initial medical necessity and ... on all patients reviewed in the ED. Conducts initial review using InterQual, MCG and other tools, assists provider...assigned. #LI-KH1 _Required_ + State licensure as a Registered Nurse (RN) + Bachelor's degree in nursing from accredited… more
- Tenet Healthcare (Detroit, MI)
- Group Director Utilization Review - 2506000536 Description : The Detroit Medical Center (DMC) is a nationally recognized health care system that serves patients ... diverse employers in Southeast Michigan. Summary Description SUMMARY: The Group Director, Utilization Review will perform the functions necessary to support and… more
- Henry Ford Health System (Troy, MI)
- …Under minimal supervision, reviews and screens the appropriateness of services, the utilization of hospital resources and the quality of patient care rendered. ... and critical thinking to maximize reimbursement. EDUCATION/EXPERIENCE REQUIRED: + Registered Nurse required. + Minimum 3-5 years of clinical experience required. +… more
- Tenet Healthcare (Detroit, MI)
- Registered Nurse Case Manager Full Time Days - 2506001582 Description : DMC Sinai-Grace Hospital is DMC’s largest hospital, offering a comprehensive heart center, ... to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patients resources and right to… more
- Molina Healthcare (Warren, MI)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases… 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
- 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 ... parking at all of our campuses ESSENTIAL DUTIES: + Utilization of a high degree of discriminative judgement while...recognized PA program that is accredited by the Accreditation Review Commission on Education for Physician Assistants and meet… more
- Corewell Health (Dearborn, MI)
- …Free onsite parking at all of our campuses Essential Functions + Utilization of a high degree of discriminative judgement while providing medical management ... Graduate of AMA recognized PA program that is accredited by the Accreditation Review Commission on Education for Physician Assistants and meet requirements of the… more
- Molina Healthcare (Warren, MI)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has a compact, multi-state license. This team reviews the prior ... requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference will be… more
- Corewell Health (Royal Oak, MI)
- …patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). 2. ... experience Three to five years' experience in care management, utilization review , home care and/or discharge planning...., home care and/or discharge planning. Preferred + Registered Nurse (RN) - State of Michigan License Upon Hire… more
- Tenet Healthcare (Detroit, MI)
- …goals and objectives that support overall strategic plans of the Case Management and Utilization Review strategy · Lead Group hospital Case Management and ... Utilization Review operations for cost-effective and clinically...business planning and project management experience preferred. Required: Registered Nurse or LCSW/LMSW license. Must be currently licensed, certified,… more
- Molina Healthcare (Warren, MI)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
- Integra Partners (Troy, MI)
- …do whatever it takes to get things done. PREFERRED SKILLS: + Certification in Utilization Review or Case Management + Experience with health insurance operations ... Integra Partners is seeking an experienced nurse educator to join our Operations Training &...team as an Operations UM Training Specialist, specializing in Utilization Management (UM) processes. The ideal candidate will have… more
- Corewell Health (Troy, MI)
- …and implementation performance evaluations, OPPE/FPPE, etc. Represents APPs to outside review services such as Joint Commission, American College of Surgeons etc. ... reviewing billing practices and monitoring metrics such as reimbursement, productivity, and utilization . + Act as central oversight for CE/CME policy including … more
- Tenet Healthcare (Detroit, MI)
- …benefit coverage and general concerns regarding policies and procedures. Maintains necessary utilization review files for all patients in the hospital. Validates ... appropriate provider. Performs input into various databases as appropriate for utilization management, LOS management and Denial Management activities. Audits data… more
- Henry Ford Health System (Detroit, MI)
- …policy issues. 3. Regularly monitors and ensures compliance with annual performance review deadlines. 4. Works closely with HR and APP recruiters, develops and ... partners, and the community as needed to promote APPs practice and utilization . General Expectations 1. Maintains an environment of open communication and teamwork.… more
- Tenet Healthcare (Detroit, MI)
- …of care inclusive of the QAPI Plan. Other oversight includes: a. utilization of telehealth/telemedicine, if used. 2. Develop and maintain the Maternal Program ... higher-level of care; and d. staff competency, training and education. 5. Consistently review the perinatal care provided and ensure the Maternal QAPI Plan is… more
- AmeriHealth Caritas (Southfield, MI)
- …plan of care, referrals, and evaluation of the effectiveness of the plan. + Review medication list and educate Members with pharmacy needs, and counsel on side ... ACFC electronic care management platforms where applicable. + Monitor appropriate utilization and coordinate services with other payer sources, make appropriate… more
- Behavioral Center of Michigan (Warren, MI)
- …records for discharge/transfer. Makes appropriate copies for various departments (Nursing, Utilization Review , Billing, and Partial Hospitalization Program). + ... and compiles records for the unit. Upholds system and organization in the nurse station, giving assistance to the assigned clinical staff in the unit. Performs… more