• Manager, Healthcare Services

    Molina Healthcare (MI)
    …performing one or more of the following activities: care review/ utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), ... identifying opportunities for improvement. **JOB QUALIFICATIONS** **Required Education** + Registered Nurse or equivalent combination of Licensed Vocational… more
    Molina Healthcare (09/27/25)
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  • Care Manager II

    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 ... accurate documentation of member interactions in the electronic care management platforms. + Monitor appropriate utilization and...the bedside (as a Registered Nurse ) working with medically fragile patients… more
    AmeriHealth Caritas (08/27/25)
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  • Clinical UM Nurse 2

    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 ... skills to make an impact** **Required Qualifications** + Licensed Registered Compact Nurse license ( RN )...volume and fast paced environment + Previous experience in utilization management + Education: BSN or Bachelor's… more
    CenterWell (09/26/25)
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  • Pharmacy Benefit Consultant

    Highmark Health (Lansing, MI)
    …**Preferred** + 5 years of experience with communications + 3 years of experience in Utilization Review + 3 years of experience in Account Support + 1 year of ... + In-depth knowledge of the pharmacy industry, including benefit design, formulary management , and pharmacy best practices. + Proven ability to interpret and analyze… more
    Highmark Health (08/26/25)
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