- Evolent (Lansing, MI)
- …Stay for the culture. **What You'll Be Doing:** Job Description The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part ... of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent… more
- Molina Healthcare (Ann Arbor, MI)
- …appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct...Chief Medical Officer for Administrative Law Judge pre-hearings, State Insurance Commission, and Meet and Confers. + Represents Molina… 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
- Corewell Health (Royal Oak, MI)
- …when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization for care and ... review, home care and/or discharge planning. Preferred + Registered Nurse (RN) - State of Michigan License Upon Hire...more! + Optional identity theft protection, home and auto insurance , pet insurance + Traditional and Roth… more
- Corewell Health (Dearborn, MI)
- …when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization for care and ... review, home care and/or discharge planning. Preferred + Registered Nurse (RN) - State of Michigan Upon Hire required...more! + Optional identity theft protection, home and auto insurance , pet insurance + Traditional and Roth… more
- Amgen (Detroit, MI)
- …Must be able to effectively collaborate across all corporate functions-MSLs, TLLs, Nurse Coordinators, Field Access Team, supporting sales teams, etc. + Key account ... payer policies and processes (eligibility and benefit verification, prior-authorization and appeals /denials) + Improve use of marketing resources to maintain and… more