• RN Senior Quality Specialist

    Corewell Health (Southfield, MI)
    …stakeholders. Also ensures continuity and coordination of services with appropriate utilization of resources. Responsible for stakeholder management across ... activities for accountable areas based on organizational priorities (project management , measurable deliverables, milestones, and data informed strategy). + Serves… more
    Corewell Health (03/13/24)
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  • Senior Analyst Business Compliance

    CVS Health (Lansing, MI)
    …Experience with URAC + Experience with NCQA -Experience supporting Clinical Business - Utilization Management , Case Management + Preference for demonstrated ... remote, candidate could be Hybrid if desired. Position Summary As a senior Analyst you will lead, implement, and maintain effective business Compliance policies… more
    CVS Health (04/25/24)
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  • Physician Clinical Reviewer-Interventional Pain…

    Evolent Health (Lansing, MI)
    …selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. ... , you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
    Evolent Health (05/01/24)
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  • Physician Clinical Reviewer- RBM

    Evolent Health (Lansing, MI)
    …Be Doing:** As a Physician Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
    Evolent Health (05/02/24)
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