- AmeriHealth Caritas (Detroit, MI)
- …psychosocial needs. This role ensures that care is delivered by Centers for Medicare & Medicaid Services ( CMS ), state, and organizational guidelines, within the ... it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other… more
- Integra Partners (Troy, MI)
- The Utilization Management (UM) Nurse Team Lead plays a key role in supporting the day-to-day operations of the UM team and serves as a liaison between frontline ... regulatory compliance. Salary: $67,000/annually JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES The UM Nurse Team Lead's responsibilities include but are not limited… more
- Gentiva (Grand Rapids, MI)
- …excellence? If so, consider bringing your clinical expertise to our Hospice Nurse Practitioner team. You'll report directly to the Executive Director or ... the physician's certification or recertification of hospice eligibility-based on CMS regulatory standards.Your assessments help ensure that patients continue to… more
- Munson Healthcare (Traverse City, MI)
- …Nationally-recognized care - our dialysis centers has been recognized by the Centers for Medicare and Medicaid Services ( CMS ) for providing some of the highest ... Traverse City Acute Inpatient Dialysis Nurse Experienced dialysis nurse preferred, will train based on nursing experience/skill level. Position requires… more
- Tenet Healthcare (Detroit, MI)
- …support post-acute needs , m) timely complete and concise documentation in Case Management system , n ) maintenance of accurate patient demographic and insurance ... Registered Nurse Case Manager Contingent Days - 2506002318 Description...requirements. This priority includes documentation in the Tenet Case Management system to communicating information through clear,… more
- Henry Ford Health System (Detroit, MI)
- …computers, electronic health records (EHR), database systems, and utilization review/case management documentation systems. + Knowledge of CMS , commercial payer ... to support patient needs beyond the hospital setting. Qualifications: + Registered Nurse (RN) with active licensure + Minimum [number] years of clinical experience… more
- Molina Healthcare (Ann Arbor, MI)
- …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases ... Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies and reports… more
- McLaren Health Care (Bay City, MI)
- …directly with patients: + Maintains AWV criteria and obtains updates from Center for Medicare and Medicaid Services ( CMS ). + Provides reimbursable RN services. + ... of an accredited school of nursing. + Current State of Michigan Registered Nurse license. + For clinics with the Rural Health Designation, Basic Life Support… more
- McLaren Health Care (Petoskey, MI)
- …with patients: Maintains AWV criteria and obtains updates from Center for Medicare and Medicaid Services ( CMS ). Provides reimbursable RN services. Conducts ... of an accredited school of nursing. + Current State of Michigan Registered Nurse license. + For clinics with the Rural Health Designation, Basic Life Support… more
- CenterWell (Lansing, MI)
- …DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare ... in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part… more