- Highmark Health (Lansing, MI)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or provider operations and/or… more
- Molina Healthcare (Sterling Heights, MI)
- …LICENSE, CERTIFICATION, ASSOCIATION:** + Active, unrestricted State Registered Nursing ( RN ) license in good standing. + Utilization Management Certification ... key medical management initiatives and analytical studies aimed at optimizing utilization of medical resources and maximizing operational efficiencies. + Engages… more
- Allegan County (Allegan, MI)
- …vaccine administration, lab draws, culture and urine collection. Education: -Licensed Practical Nurse (LPN) or Associates Degree RN required -Bachelor's Degree ... RN (BSN) preferred License / Certification: + Current Michigan RN License required + Current Michigan Driver's License required + Current AED, BLS Certification… more
- University of Michigan (Ann Arbor, MI)
- …seeking experienced Emergency Department (ED) Technicians. Under the direction of the RN , the Emergency Department Technician will perform patient care services and ... family centered adult emergency care. As directed and supervised by an RN , major responsibilities for Emergency Department Technician include: + Providing safe and… more
- CVS Health (Lansing, MI)
- …and/or clinical audit experience. + Experience in medical management, including Utilization Management (UM) and Case Management (CM). + Strong understanding of ... accreditation processes, and NCQA standards. + Licensed clinical professional ( RN preferred). + Excellent analytical, organizational, and communication skills. +… more
- Humana (Lansing, MI)
- …Rico. + Active licensed RN in state of employment + 3 years clinical RN experience + 2 years of Utilization Review, Case Management, or Quality Management ... experience + Strong analytical skills, experience manipulating and interpreting data + Ability to work 7 - 4 pm ET or 8 - 5 pm ET **Preferred Qualifications** + Accreditation (URAC, NCQA or JCAHO) experience + Quality Management experience **Work at Home… more
- Henry Ford Health System (Troy, MI)
- …treatment plans for purposes of obtaining authorizations. + Ability to interpret RN or Physician notes in order to facilitate obtaining authorizations. + Ability ... to evaluate & communicate to RN /Physician staff additional requirements or roadblocks. + Additional coursework in business, computers or health care administration,… more
- US Tech Solutions (MI)
- …with regulatory and accreditation guidelines and company policies and procedures **Skills:** + Utilization review + RN + Assure care + Clinical practice + ... office working environment with productivity and quality expectations. **Education:** RN with current unrestricted state licensure. **About US Tech Solutions:**… more
- McLaren Health Care (Pontiac, MI)
- …needs and community service needs within 24 hours of admission. 2. Receives RN Care Manager referrals to social work based on identified Social Work Triggers ... knowledge of insurance benefits and coverage guidelines to maximize appropriate utilization of resources. 13. Documents in the EMR: assessment, plans, interventions,… more
- Evolent (Lansing, MI)
- …mission. Stay for the culture. **What You'll Be Doing:** The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Cardiology is responsible for support and assistance ... for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices of the office of the Chief Medical… more
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