• Regional Manager, Clinical Documentation Integrity…

    Trinity Health (Livonia, MI)
    …Nursing or the equivalent in experience. Must possess one of the below: + Current Registered Nurse ( RN ) License + Registered Health Information ... Full time **Shift:** Day Shift **Description:** **POSITION PURPOSE** Work Remote Position Responsible for directing Clinical Documentation Integrity (CDI) activities… more
    Trinity Health (10/08/25)
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  • Program Manager, Healthcare Services (Contract…

    Molina Healthcare (Sterling Heights, MI)
    …transitions, behavioral health, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ), Licensed Vocational Nurse (LVN), ... external vendors. * Focuses on process improvement, organizational change management , program management and other processes relative...years in one or more of the following areas: utilization management , care management , care… more
    Molina Healthcare (11/13/25)
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  • REMOTE Revenue Integrity Nurse…

    Trinity Health (Livonia, MI)
    …& denial management functions + Knowledge of and experience in case management and utilization management . + Customer service background is required. ... **Preferred:** + Registered Nurse + Bachelor's degree + Two plus (2+) years of charge audit, managed care or comparable patient payment processing experience… more
    Trinity Health (11/15/25)
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  • Transplant Care Nurse ( Remote )

    Highmark Health (Lansing, MI)
    …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... in addressing targeted populations **LICENSES or CERTIFICATIONS** **Required** + RN license in PA or WV or DE or...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
    Highmark Health (11/06/25)
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  • Central Authorization Specialist/Full Time/…

    Henry Ford Health System (Troy, MI)
    …records and related documentation. + Current working knowledge of hospital operations, utilization management , case management , and managed care ... procurement is obtained from back end coding, billing and denial management resources and distributed to ordering physicians and authorization procurement staff… more
    Henry Ford Health System (11/06/25)
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  • UM Behavioral Health Nurse

    Humana (Lansing, MI)
    **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills ... and communication of behavioral health services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work… more
    Humana (11/15/25)
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  • Case Manager

    AmeriHealth Caritas (Detroit, MI)
    …required. + Bachelor of Science in Nursing preferred. + Current, active, and unrestricted Registered Nurse licensure. + 3 or more years of clinical experience at ... and compliance with treatment plans, as well as promote self- management . **Work Arrangement:** + Remote - The...the bedside (as a Registered Nurse ) working with medically fragile patients… more
    AmeriHealth Caritas (11/11/25)
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  • Data Management Lead

    Parexel (Lansing, MI)
    …Title:** Data Management Lead (Medical Affairs) - Oncology **Location:** Fully Remote (US based) Must be able to accommodate West Coast hours. **About Us:** ... solutions. We are seeking a dynamic and experienced Data Management Lead to join our team. If you have...practices like version control and literate programming. + BSN, RN , RPh, Pharm D, PA, MPH, or other applicable… more
    Parexel (10/11/25)
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  • Quality Audit Professional

    Humana (Lansing, MI)
    …of employment + 3 years clinical RN experience + 2 years of Utilization Review, Case Management , or Quality Management experience + Strong analytical ... The Quality Audit Professional 2 supports the Healthcare Quality Management Team in administering and implementing the Clinical Quality...+ Active licensed RN in state… more
    Humana (11/14/25)
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  • Clinical UM Nurse

    CenterWell (Lansing, MI)
    **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and ... an impact** **Required Qualifications** + Must be a licensed Registered Compact Nurse license ( RN )...volume and fast paced environment + Previous experience in utilization management + Education: BSN or bachelor's… more
    CenterWell (11/12/25)
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