- Henry Ford Health System (Detroit, MI)
- …+ Proficiency with computers, electronic health records (EHR), database systems, and utilization review /case management documentation systems. + Knowledge of ... resources to optimize patient outcomes and promote efficient resource utilization . Key Responsibilities: Clinical Care Coordination: + Conduct comprehensive patient… more
- Veterans Affairs, Veterans Health Administration (Detroit, MI)
- …local HBPC policies and procedures to include performance improvement, patient safety, utilization review , emergency preparedness, and staff safety. He/she is ... demonstrate leadership, experience, and creative approaches to complex patient care management .The HBPC Registered Nurse Program Director/Manager is an expert… more
- Elevance Health (Dearborn, MI)
- …for employment, unless an accommodation is granted as required by law. The **Medical Management Nurse ** is responsible for review of the most complex ... **Medical Management Nurse ** **Hours: Candidates will work...experience and requires a minimum of 2 years clinical, utilization review , or case management … more
- CVS Health (Lansing, MI)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Henry Ford Health System (Detroit, MI)
- The Certified Registered Nurse Anesthetist (CRNA) Manager is a Certified Registered Nurse Anesthetist who ensures the delivery of safe anesthetic patient care in ... hospital/system leaders to develop a quality practice setting that supports professional nurse anesthesia practice and quality patient care. The CRNA Manager is… more
- Molina Healthcare (Sterling Heights, MI)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and...the specific programs supported by the plan such as Utilization Review , Medical Claims Review ,… more
- Evolent (Lansing, MI)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management … more
- Trinity Health (Ann Arbor, MI)
- …time **Shift:** Day Shift **Description:** **POSITION PURPOSE** + The Registered Nurse Case Manager assumes overall accountability for patients' discharge plans ... leadership role in achieving desired clinical, financial and resource utilization outcomes. + This is achieved by coordinating care...Friday. **WHAT YOU WILL DO** + The RN Registered Nurse Case manager is responsible for conducting a focused… more
- Highmark Health (Lansing, MI)
- …triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, ... Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or… more
- Hospice of Michigan (Southfield, MI)
- …work with minimal supervision. + Requires knowledge of quality assessment and utilization review functions, principles and practices. + Theoretical and practical ... personnel on the QAPI plan, and team development. + Performs clinical record review activities for data collection. + Compiles, analyzes, trends and reports quality… more