• * RN Coordinator- Utilization…

    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
    Henry Ford Health System (09/25/25)
    - Related Jobs

  • RN , Manager, Utilization Management…

    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
    Humana (09/28/25)
    - Related Jobs

  • Utilization Management Nurse…

    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 (09/24/25)
    - Related Jobs

  • Utilization Management Nurse…

    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
    CVS Health (09/25/25)
    - Related Jobs

  • Medical Claim Review Nurse…

    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
    Molina Healthcare (09/06/25)
    - Related Jobs

  • 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 ... 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
    CenterWell (09/06/25)
    - Related Jobs

  • RN Case Manager: University Hospital (Care…

    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
    University of Michigan (09/16/25)
    - Related Jobs

  • Infusion Referral Nurse Sr- REMOTE…

    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
    Prime Therapeutics (09/04/25)
    - Related Jobs

  • Supervisor, Clinical Documentation Integrity (CDI)…

    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
    Trinity Health (08/26/25)
    - Related Jobs

  • Disease Management Nurse - Remote

    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
    Sharecare (09/13/25)
    - Related Jobs