- Allegan County (Allegan, MI)
- …makes appropriate referrals, utilizing resources + Provides comprehensive case management and coordinates services provided through a multidisciplinary approach ... in the community as assigned. + Provides prevention and health education, case management , and care to individuals and families, in coordination with health care… more
- Pine Rest Christian Mental Health Services (Grand Rapids, MI)
- …staff assignments and promoting staff development. + Responsible for the utilization and continued review of patient care protocols, standards ... to be a part of this incredible work. What Will You Do? As a Registered Nurse at Pine Rest, you'll be part of tight-knit team that believes in the healing power… more
- Corewell Health (Dearborn, MI)
- …even home and auto insurance + Free onsite parking Essential Functions + Utilization of a high degree of discriminative judgement while providing medical ... management including assessment of medical and psychosocial status, comprehensive...recognized PA program that is accredited by the Accreditation Review Commission on Education for Physician Assistants and meet… more
- US Tech Solutions (MI)
- …with regulatory and accreditation guidelines and company policies and procedures **Skills:** + Utilization review + RN + Assure care + Clinical practice + ... + Through the use of clinical tools and information/data review , conducts comprehensive assessments of referred member's needs/eligibility and determines… more
- Highmark Health (Lansing, MI)
- …regulatory requirements. Documents, processes and routes requests for services to the nurse reviewer and other departments based on documentation procedures, ... and notification requirements are met. + Communicate effectively with Utilization Management Staff, providers, other internal and...accurate and timely routing of service requests to the nurse reviewer to assure that the decision… more
- Fresenius Medical Center (Sandusky, MI)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Molina Healthcare (Warren, MI)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT… more
- Molina Healthcare (Sterling Heights, MI)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary… more
- Corewell Health (Dearborn, MI)
- …discharge planning of all hospitalized patients. + Identifies patients that need care management services (ie utilization review ; care coordination; and/or ... relevant experience Three to five years' experience in care management , utilization review , home care..., home care and/or discharge planning. Preferred + Registered Nurse (RN) - State of Michigan Upon Hire required… more
- Corewell Health (Royal Oak, MI)
- …discharge planning of all hospitalized patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; and/or ... relevant experience Three to five years' experience in care management , utilization review , home care..., home care and/or discharge planning. Preferred + Registered Nurse (RN) - State of Michigan License Upon Hire… more
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