• RN Clinical Manager

    CenterWell (Portage, MI)
    …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... delivery, and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance … more
    CenterWell (09/06/25)
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  • Patient Care Manager - Full Time (32 Hours/Week)

    Munson Healthcare (Traverse City, MI)
    …facilitate the progress of completing complex post-acute services + Interface with utilization review specialists to stay current on patient's eligibility for ... service/interpersonal skills at all times. + Maintains working knowledge/experience in utilization management, managed care, and payer issues that may impact the… more
    Munson Healthcare (10/15/25)
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  • Patient Access Liaison (Pre-Transplant/Kidney)

    Henry Ford Health System (Detroit, MI)
    …the physician FTE breakdown (ie inpatient vs. outpatient time, research, medical education, and others). + Facilitate referring physician and patient access ... from director and division head or chair. + Tracks utilization , lead-time, and all other access related issues. +...be required to meet demand. + Manage and monitor physician and midlevel provider requests for clinic schedule closure… more
    Henry Ford Health System (10/09/25)
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  • Multi-Site Director Case Management

    Prime Healthcare (Port Huron, MI)
    …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. Assesses ... Overview Lake Huron Medical Center is a 139-bed community hospital that...which offers patient-centered care through primary and specialty care physician practices located throughout the Blue Water Area. Raising… more
    Prime Healthcare (10/13/25)
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  • Rehab Care Coordination Specialist Full Time Days

    Tenet Healthcare (Detroit, MI)
    …resolve conflict. Promotes a positive customer relations environment. Coordinates the utilization review function for assigned patients. Performs periodic ... assessment and client progress to appropriate parties. Refers all concerns regarding medical necessity, inappropriate utilization of resources or quality issues… more
    Tenet Healthcare (10/15/25)
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  • Intake Specialist, Michigan - McLaren Careers

    McLaren Health Care (Flint, MI)
    …or other health care setting. **Preferred:** + One (1) year Managed Care Utilization review experience. + Experience and knowledge of the preauthorization ... at the most appropriate and cost-effective setting. Monitors members' utilization patterns for identification of high-risk and under and...process for medical services. + Physician office experience. +… more
    McLaren Health Care (10/28/25)
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  • Data Analytics Specialist -Fleet

    City of Detroit (Detroit, MI)
    …department's vehicle and specialized equipment replacement program; analyze fleet utilization and recommend replacements or reallocations based on operational needs. ... to build relationships within and across organizations and units. Medical Plan Offering for Administrative Special Services Employees The...plan. You will have to choose a primary care physician that serves within the PCP Focus network. This… more
    City of Detroit (10/25/25)
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  • Clinical Reviewer, Nurse -9am -6pm PST

    Evolent (Lansing, MI)
    …quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on ... Director direction, using independent nursing judgement and decision-making, physician -developed medical policies, and clinical decision-making criteria sets.… more
    Evolent (10/21/25)
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  • Denials Prevention Specialist PRN

    Datavant (Lansing, MI)
    …software tools. The specialist serves as a key liaison between coding, billing, utilization review , case management, and payer relations to reduce denials and ... throughout the entire revenue cycle, including registration, eligibility, coding, billing, and medical necessity. + Analyze denial trends and root causes using data… more
    Datavant (10/08/25)
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  • Licensed Practical Nurse - Rehab - McLaren Careers

    McLaren Health Care (Port Huron, MI)
    …* Responsible for the total nursing care of residents as directed by the Medical Director, attending physician , Director of Nursing and designated alternates. * ... Summary:** The License Practical Nurse delivers quality nursing care through the utilization of the nursing process. Works collaboratively with other members of the… more
    McLaren Health Care (10/29/25)
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