- Fresenius Medical Center (Romulus, MI)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Fresenius Medical Center (Mount Pleasant, MI)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Tenet Healthcare (Detroit, MI)
- Registered Nurse Case Manager Contingent Days - 2506002318 Description : DMC Sinai-Grace Hospital is DMC's largest hospital, offering a comprehensive heart ... for case management scope of services including: Utilization Management supporting medical necessity and denial... experience preferred. 3. License to practice as a Registered Nurse in the State of Michigan.… more
- CVS Health (Lansing, MI)
- …care. + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse ( RN ) with at least 1 year of experience ... is URAC accredited in Case Management , Disease Management and Utilization Management . AHH...in a hospital setting. + A Registered Nurse that holds an active, unrestricted… more
- Evolent (Lansing, MI)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management … more
- Henry Ford Health System (Troy, MI)
- …screening criteria and critical thinking to maximize reimbursement. EDUCATION/EXPERIENCE REQUIRED: + Registered Nurse required. + Minimum 3-5 years of clinical ... required. + Bachelor of Science Nursing required OR four (4) years Case Management / Appeal/ Utilization Management experience in lieu of bachelor's degree.… more
- Trinity Health (Livonia, MI)
- …of clinical experience in nursing and recent (within 2 year) experience in utilization review / management /discharge planning or case management . Current ... Care Team as a** **Case Manager** **in the Case Management Department awaits YOU ** **_St. Joseph Mercy Health...criteria. Knowledge of federal, state and local regulation affecting utilization review programs and payments. Knowledge of… more
- McLaren Health Care (Petoskey, MI)
- …+ Four years of professional experience in RN patient care and case management and/or utilization review QUALIFICATIONS PREFERRED + Master's degree in ... supplies and minor equipment purchases. + Fosters smoothly running case management and utilization review services and processes through timely and effective… more
- Molina Healthcare (Ann Arbor, MI)
- …team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review , and/or other utilization management activities ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management , ensuring compliance with regulatory and accrediting… more
- Sedgwick (Lansing, MI)
- …PURPOSE** :: To ensure efficient, cost effective, and high quality delivery of case management and utilization review services to clients for multiple ... client locations; to provide expertise in client specific case management and utilization review requirements;...**QUALIFICATIONS** **Education & Licensing** For Managed Care: Current unrestricted RN license in a state or territory of the… more