- Henry Ford Health System (Warren, MI)
- …screening criteria and critical thinking to maximize reimbursement. EDUCATION/EXPERIENCE REQUIRED: + Registered Nurse required. + Minimum 3-5 years of clinical ... Management experience in lieu of bachelor's degree. CERTIFICATIONS/LICENSURES REQUIRED: + Registered Nurse with a valid, unrestricted State of Michigan License.… more
- Humana (Lansing, MI)
- …areas. **Use your skills to make an impact** **Required Qualifications** + An active, unrestricted Registered Nurse ( RN ) license in the state of Michigan. + ... Previous experience in utilization management and/or utilization review ....business administration. **Additional Information** + **Workstyle:** This is a remote position. + **Travel:** Up to 25% travel may… more
- CVS Health (Lansing, MI)
- …healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. **Position Summary** The Team Lead plays ... 5+ years of clinical practice experience in medical healthcare. + 3+ years Medical Review or Utilization Management experience. + 2+ years of experience with… more
- CVS Health (Lansing, MI)
- …during shift times are not permitted. **Required Qualifications** + Active unrestricted state Registered Nurse licensure in state of residence required. + 1+ ... may vary based on business needs) **Location** : 100% Remote (US only) **Position Summary** American Health Holding, Inc....high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant - Oncology… more
- Molina Healthcare (Warren, MI)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing… more
- CenterWell (Portage, MI)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- University of Michigan (Ann Arbor, MI)
- …position is unique in that it combines clinical/quality considerations with regulatory/financial/ utilization review demands. The position creates a balance ... RN CASE MANAGER: University Hospital (Care Management) Apply...+ Participate in venues to reduce barriers to discharge ** Utilization Review and Utilization Management**… more
- Prime Therapeutics (Lansing, MI)
- …Patient Programs. **Minimum Qualifications** + Associates - Nursing + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - ... for work visa or residency sponsorship **Additional Qualifications** + Registered Nurse ( RN ). + Oncology...Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. +… more
- Trinity Health (Livonia, MI)
- …or Nursing or equivalent in experience. Must possess one of the below: + Current Registered Nurse ( RN ) License + Registered Health Information ... Type:** Full time **Shift:** Day Shift **Description:** **POSITION PURPOSE** Work Remote Position At the direction of the Regional Manager, Clinical Documentation… more
- Sharecare (Lansing, MI)
- …to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they ... utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification… more