- Centene Corporation (Lansing, MI)
- …with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment, Operations (claims and encounters). + Schedules doctor appointments for ... customer service to resolve member issues. + Refers to case or disease management as appropriate. + Completes special assignments and projects instrumental to the… more
- Select Medical (Pontiac, MI)
- …(PRN)** _Requires a current licensure in a clinical discipline either as a Nurse or a Respiratory Therapist OR Social Work SW/MSW (potential license per state ... right. The Case Manager is responsible for utilization reviews and resource management , discharge planning, treatment plan management and financial management… more
- Molina Healthcare (MI)
- …practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk adjustment, ... regarding utilization practices, guideline usage, pharmacy utilization and effective resource management . + Develops and implements a Utilization Management … more
- Select Medical (Mount Clemens, MI)
- …8-5pm** _Requires a current licensure in a clinical discipline either as a Nurse (RN/LPN/LVN) or a Respiratory Therapist (RT) OR Medical Social Work (license per ... right. The Case Manager is responsible for utilization reviews and resource management , discharge planning, treatment plan management and financial management… more
- ProMedica Health System (Adrian, MI)
- …Requisition Qualifies for Sign on Bonus **Bonus Amount:** $5,000 **Job Summary:** The Registered Nurse (RN) is at the core of our world class patient care team. The ... active partnerships that promote health, safety and well-being, and self-care management . + Addresses patient/family education needs considering patient level of… more
- ChenMed (Eastpointe, MI)
- …+ Conflict management and resolution skills, and ideally, experience of population risk management or complex chronic disease care management + Effective ... to ensure compliance with guidelines along with participating in risk and quality management programs, clinical meetings...( _with the support of the Care Team and Nurse Practitioner/Physician Assistant depending on ratio_ ). + Assesses… more
- Sedgwick (Grand Rapids, MI)
- …skills needed for particular employment positions; makes decisions or assists case management staff in making decisions regarding a client's competence in performing ... team to: a) ensure smooth transition from medical case management into job placement; and/or b) discuss the progress...change the duties of the position at any time. \# nurse Sedgwick is an Equal Opportunity Employer and a… more
- Sedgwick (Grand Rapids, MI)
- …+ Provides clear and appropriate follow-up recommendations for ongoing medical management of claims; ensures appropriate recommendations are made on claims. + ... + Knowledge of current medical practices in health care management in a variety of areas (including, but not...change the duties of the position at any time. \# nurse Sedgwick is an Equal Opportunity Employer and a… more
- Superior Ambulance Service (Warren, MI)
- … Education including Human Factors/Crew Resource Management , Stress and Fatigue Management , Safety and Risk Management , and Quality Management ... and will be an integral part of the ambulance management team. Responsibilities + Provide leadership and structure to...Emergency Medical Technician, Paramedic, Critical Care Paramedic or Transport Nurse Desired : + One (1) year experience on… more
- Travelers Insurance Company (Lansing, MI)
- …resources for specific activities required to effectively evaluate claims, such as Subro, Risk Control, nurse consultants and fire or fraud investigators and ... service on assigned claims, while engaging in indemnity & expense management . Promptly manage claims by completing essential functions including contacts,… more