- McLaren Health Care (Port Huron, MI)
- …peer to peer reviews with payer/providers. 7. Actively participates in clinical case review /rounds with the interdisciplinary team regarding continued ... **Department:** Utilization Review **Daily Work Times:** 8:00am-4:30pm **Hours Per Pay...to support the level of care being billed. Conducts concurrent reviews to ensure criteria for patient status and… more
- McLaren Health Care (Bay City, MI)
- …peer to peer reviews with payer/providers. 7. Actively participates in clinical case review /rounds with the interdisciplinary team regarding continued ... documentation is sufficient to support the level of care being billed. Conducts concurrent reviews to ensure criteria for patient status and continued stay are met… more
- University of Michigan (Ann Arbor, MI)
- …Minimum of five (5) years of nursing experience with demonstration of progressive clinical competence + Nurse Leadership certification or completion within two ... CLINICAL NURSING DIRECTOR (CS Mott Children's Hospital: 10-West...of their children. The Pediatric Cardiothoracic Intensive Care Unit nurse cares for patients in a technology-intensive environment, including… more
- Tenet Healthcare (Detroit, MI)
- …for Secondary Physician review per Tenet policy. Ensures timely communication of clinical data to payers to support admission, level of care, length of stay and ... Registered Nurse Case Manager (RN) - 2506003132 Description :...accurate medical necessity screening and submission for Physician Advisor review , b) care coordination, c) transition planning assessment and… more
- Trinity Health (Ann Arbor, MI)
- …psychosocial, environmental, economic/financial and discharge planning needs. + One would also review , on a concurrent basis, the appropriateness, intensity, and ... time **Shift:** Day Shift **Description:** **POSITION PURPOSE** + The Registered Nurse Case Manager assumes overall accountability for patients' discharge plans… more
- Henry Ford Health System (Warren, MI)
- …criteria and critical thinking to maximize reimbursement. EDUCATION/EXPERIENCE REQUIRED: + Registered Nurse required. + Minimum 3-5 years of clinical experience ... of hospital resources and the quality of patient care rendered. Combines clinical , business, regulatory knowledge, and skill to reduce significant financial risk and… more
- Trinity Health (Livonia, MI)
- …services. Responsible for charge capture in Revenue Integrity assigned areas. Review 's chart, including nursing notes, physician orders, progress notes, and surgical ... correct encounter, correct date of service, with any required modifiers. Review 's documentation, abstracts data and ensure charges/coding are in alignment within… more
- Molina Healthcare (MI)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care ... national, state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM reviews + MD licenses required for the… more
- Oracle (Lansing, MI)
- …(ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal ... of analysts providing support for operationally required changes and enhancements to clinical applications, and aa group of analysts leading projects that will… more
- Molina Healthcare (Detroit, MI)
- …requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial process. * Monitors appropriate care ... for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership and consultation… more