- Tenet Healthcare (Detroit, MI)
- …avoidable readmissions. This position integrates national standards for case management scope of services including: Utilization Management supporting ... orientation includes review and instruction regarding Tenet Case Management and Compliance policies, InterQual, Transition...policies, InterQual, Transition Management , Utilization Management , and other topics specific to case … more
- Tenet Healthcare (Detroit, MI)
- …is required. Department orientation includes review and instruction regarding Tenet Case Management and Compliance policies, Transition Management , and ... Clinical Social Worker Case Management Contingent Days - 2406004694...leading and/or facilitating multi-disciplinary patient care conferences including Complex Case Review , f) making appropriate referrals to… more
- Trinity Health (Livonia, MI)
- …experience in nursing and recent (within 2 year) experience in utilization review / management /discharge planning or case management . Current knowledge ... Opportunity to Join our Remarkable Care Team as a** ** Case Manager** **in the Case Management...criteria. Knowledge of federal, state and local regulation affecting utilization review programs and payments. Knowledge of… more
- CVS Health (Lansing, MI)
- …and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards ... of care to meet the member's goals + Utilizes case management and quality management ...discharge planning experience + Crisis intervention skills + Managed care/ utilization review experience + Ability to take… more
- CVS Health (Lansing, MI)
- …within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers ... overcome barriers to meeting goals and objectives. + Utilizes case management processes in compliance with regulatory...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Tenet Healthcare (Commerce Township, MI)
- …and prevent avoidable readmissions. This position integrates national standards for case management scope of services including: Transition Management ... staff and ancillary departments, k) leading and facilitating Complex Case Review , l) assuring patient education is...m) timely complete and concise documentation in the Tenet Case Management documentation system, n ) maintenance… more
- Trinity Health (Chelsea, MI)
- …Type:** Part time **Shift:** Day Shift **Description:** **Registered Nurse** ** Case Manager** **Department:** Utilization Management **Location:** ... population through the use of care plans, critical pathways, managed care, and utilization review processes and collaboration with all members of the health… more
- Trinity Health (Chelsea, MI)
- …Type:** Part time **Shift:** Rotating Shift **Description:** **Registered Nurse** ** Case Manager** **Department:** Utilization Management **Location:** ... population through the use of care plans, critical pathways, managed care, and utilization review processes and collaboration with all members of the health… more
- Elevance Health (Dearborn, MI)
- …to work East Coast time zone hours.** The **Medical Director** will be responsible for utilization review case management for Commercial business in the ... and external physicians. + May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- US Tech Solutions (MI)
- …+ Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards ... needs to ensure appropriate administration of benefits + Utilizes case management and quality management ...accreditation guidelines and company policies and procedures **Skills:** + Utilization review + RN + Assure care… more