• Director, Risk Adjustment Prospective Operations…

    Corewell Health (Grand Rapids, MI)
    …implementing risk adjustments programs for Medicare Advantage or ACA products. Preferred + LIC- Registered Nurse ( RN ) - STATE_MI State of Michigan Upon ... initiatives through the Prospective team members via provider education, chart audit , etc. + Internal stakeholder management:...Hire required Or + LIC- Registered Nurse ( RN ) - State… more
    Corewell Health (07/21/25)
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  • Diagnosis Related Group Clinical Validation…

    Elevance Health (Dearborn, MI)
    …and efficiency recommendations. **Minimum Requirements:** + Requires current, active, unrestricted Registered Nurse license in applicable state(s). + Requires a ... **Diagnosis Related Group Clinical Validation Auditor- RN ** **Virtual:** This role enables associates to work...impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the… more
    Elevance Health (08/09/25)
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  • Clinical Quality Nurse Specialist

    Hospice of Michigan (Kalamazoo, MI)
    …every time, 100% of the time. Qualifications: + Bachelor of Science in Nursing preferred. Registered Nurse ( RN ) licensure in the State of Michigan required. ... support of the mission of NorthStar Care Community. The Clinical Quality Nurse Specialist is responsible, through monitoring and supporting clinical staff, for… more
    Hospice of Michigan (08/09/25)
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  • Revenue Integrity - Nurse Auditor

    Trinity Health (Ann Arbor, MI)
    …travelling between locations within the region. **MINIMUM QUALIFICATIONS** **Licensure/Certification:** Registered Nurse or Licensed Vocational Nurse / ... optimization. Investigates denials and root causes, which includes performing thorough chart reviews, providing education to clinical colleagues, and tracking of… more
    Trinity Health (07/11/25)
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