- Evolent (Lansing, MI)
- …LCSW, and LPCs, Clinical Reviewers. Opportunities to work collaboratively with other Utilization Management Leaders including our Director may also be available. ... the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management** at Evolent will serve as a point...also works with our clinical team, which includes our medical reviews: LVNs, LPNs, and RNs along with our… more
- Integra Partners (Troy, MI)
- …policies). + Review and process clinical and administrative appeals; coordinate with Medical Director when required. + Generate and review daily/weekly reporting ... The Utilization Management ( UM ) Nurse Supervisor is...with DMEPOS authorization and appeals processes. + Knowledge of medical necessity criteria (InterQual, CMS, health plan policies). +… more
- Humana (Lansing, MI)
- …for Humana's dual eligible members. + Serves as a liaison between Humana utilization management ( UM ) operations and the State of Michigan regarding prior ... of our caring community and help us put health first** The Utilization Management Nurse Lead uses clinical knowledge, communication skills, and independent critical… more
- Molina Healthcare (Sterling Heights, MI)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under- utilization...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- CVS Health (Lansing, MI)
- …Health, Health Equity and Quality programs. 2. Collaborating with the Medical Management stakeholders both internally ( UM /CM, Pharmacy, Quality, network, ... excellence, achieving measurable health outcomes, and supporting quality and medical management in a highly matrixed environment. The CMO...and analyze data and trends at State level in: UM , CM, Pop Health and Health Equity in order… more
- Corewell Health (Farmington Hills, MI)
- …status and level of care. Uses defined resources to guide decisions, including Medical Director Care Management, Physician Advisors, and management staff. + ... hospital outpatient, observation or inpatient services. + May review cases for medical necessity, uses InterQual and/or other UR/ UM Committee-approved medical… more
- Corewell Health (Royal Oak, MI)
- …status and level of care. Uses defined resources to guide decisions, including Medical Director Care Management, Physician Advisors, and management staff. 5. ... hospital outpatient, observation or inpatient services. 4. May review cases for medical necessity, uses InterQual and/or other UR/ UM Committee-approved … more
- Evolent (Lansing, MI)
- …sources to establish and maintain the definitive source of truth for specialty Utilization Management ( UM ) agreements. This important work is achieved through ... and financial scope within Evolent Specialty Services. Reporting to the Director , Clinical Informatics, this role is responsible for acquiring, synthesizing, and… more
- University of Michigan (Ann Arbor, MI)
- …for accuracy and investigate and implement potential cost savings strategies. Track utilization of products and make recommendations for PAR changes and new products ... Supervises process of recruitment for the Critical Care hiring team. Obtains director approval to create job postings and update posting descriptions. Works closely… more