- Cognizant (Lansing, MI)
- …cycle or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews . ... have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical ...stand out** . Epic experience . Experience in drafting appeals disputing inpatient clinical validations audits is… more
- McLaren Health Care (Grand Blanc, MI)
- …and commercial insurance. 8. Educates health team colleagues about complex clinical appeals , utilization review, including role, responsibilities tools, and ... management, clinical documentation, or utilization review experience + Five years of clinical nurse experience in an acute care setting + American Case… more
- McLaren Health Care (Mount Clemens, MI)
- …outcomes and fulfills the obligation and responsibilities of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer ... . Provides support to both internal and external customers for denial/ appeals activities and audits. Assists with monitoring and auditing activities, reviews… more
- Molina Healthcare (Warren, MI)
- …resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical ... (Team will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing clinical knowledge… more
- Molina Healthcare (MI)
- …national, state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM reviews + MD licenses required for the ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more
- McLaren Health Care (Grand Blanc, MI)
- …of Medicine Degree **.** **4 years of utilization management, case management, clinical documentation, and/or denials/ appeals experience in an acute healthcare ... trends and direction to assist front-end processes such as utilization management, clinical documentation improvement, coding, and billing etc. to reduce denials. 4.… more
- Corewell Health (Royal Oak, MI)
- …criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization ... adult and Level II pediatric trauma designations. The advanced capabilities and clinical expertise within this center have earned it Magnet designation four… more
- Corewell Health (Dearborn, MI)
- …criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization ... care management, utilization review, home care and/or discharge planning. Preferred + Registered Nurse (RN) - State of Michigan Upon Hire required + Basic Life… more