- Integra Partners (Troy, MI)
- …in a payer or managed care environment. + Strong understanding of utilization review , authorizations, and appeals processes. + Excellent verbal/written ... The Utilization Management (UM) Nurse Supervisor is...and process clinical and administrative appeals; coordinate with Medical Director when required. + Generate and review … more
- Humana (Lansing, MI)
- …enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse , with a focus on our 5+ million ... The Director , Physician leadership will lead Medical Directors performing utilization management for inpatient authorizations training medical director team… more
- Molina Healthcare (Grand Rapids, MI)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
- Sedgwick (Lansing, MI)
- …(10) of related experience required to include one (1) to three (3) years utilization review experience and three (3) years clinical quality control. **Skills & ... Workplaces in Financial Services & Insurance Sr. VP Medical Director **PRIMARY PURPOSE** **:** To evaluate medical reports escalated...+ Knowledge of ADAA and FMLA + Knowledge of utilization review procedures + Knowledge of clinical… more
- Veterans Affairs, Veterans Health Administration (Ann Arbor, MI)
- …intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, ... Kettles VA Medical Center is seeking a Full-Time Registered Nurse (RN) - Community Care aligned under Chief of...and approving supervisors and is accountable to the Associate Director of Patient Care Services (ADPCS). VA offers a… more
- Prime Healthcare (Port Huron, MI)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. Assesses ... to creating a positive and supportive work environment. Responsibilities The Regional Director of Case Management will be responsible for the operations of the… more
- YesCare Corp (Port Huron, MI)
- …measures including sentinel event review . + Actively participant of the Utilization Review process and follow proper procedures. + Provides appropriate ... or nurse practitioners as required. + Notifies Regional Medical Director and Site Health Services Administrator of schedule changes. Assists in arrangement… more
- McLaren Health Care (Port Huron, MI)
- …Work Times:** Per Diem **Scheduled Bi-Weekly** **Position Summary:** The License Practical Nurse delivers quality nursing care through the utilization of the ... nursing care of residents as directed by the Medical Director , attending physician, Director of Nursing and...and verbal communication. * Participates in the resident care review process and assists in establishing resident goals, problem… more
- Corewell Health (Farmington Hills, MI)
- …patients. + Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). + ... years of relevant experience Three to five years' experience in care management, utilization review , home care and/or discharge planning. Preferred + Registered … more
- Corewell Health (Royal Oak, MI)
- …patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). 2. ... years of relevant experience Three to five years' experience in care management, utilization review , home care and/or discharge planning. Preferred + Registered … more