• Medical Claim Review Nurse…

    Molina Healthcare (Warren, MI)
    …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… more
    Molina Healthcare (09/06/25)
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  • RN Clinical Manager

    CenterWell (Portage, MI)
    …license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
    CenterWell (09/06/25)
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  • RN Case Manager

    Trinity Health (Chelsea, MI)
    …Type:** Part time **Shift:** Rotating Shift **Description:** ** Registered Nurse ** **Case Manager** **Department:** Utilization Management **Location:** ... + Tuition Reimbursement **Position Purpose:** Exceptional opportunity for a Registered Nurse Case Manager to support our...use of care plans, critical pathways, managed care, and utilization review processes and collaboration with all… more
    Trinity Health (09/03/25)
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  • RN Lead, Healthcare Services

    Molina Healthcare (Sterling Heights, MI)
    …least 2 years of managed care experienced in utilization management * Registered Nurse ( RN ) ONLY if required by state contract, regulation or state ... skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse ( RN ). License must be active and… more
    Molina Healthcare (09/26/25)
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  • Infusion Referral Nurse Sr- REMOTE/Oncology…

    Prime Therapeutics (Lansing, MI)
    …Patient Programs. **Minimum Qualifications** + Associates - Nursing + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - ... for work visa or residency sponsorship **Additional Qualifications** + Registered Nurse ( RN ). + Oncology...experience. + Experience in managed care, specialty drugs, care management and utilization review . +… more
    Prime Therapeutics (09/04/25)
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  • RN , Geriatric Acute Mental Healthcare

    Pine Rest Christian Mental Health Services (Grand Rapids, MI)
    …Pine Rest (https://www.pinerest.org/inpatient-services/services/older-adult-inpatient-services/) What Will You Do? As a Registered Nurse at Pine Rest, you'll be ... staff assignments and promoting staff development. + Responsible for the utilization and continued review of patient care protocols, standards… more
    Pine Rest Christian Mental Health Services (08/09/25)
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  • RN Clinical Appeals Nurse

    Molina Healthcare (Detroit, MI)
    …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
    Molina Healthcare (09/26/25)
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  • RN Case Manager Clinical Res Mgmt Full Time…

    Tenet Healthcare (Commerce Township, MI)
    …planning experience. Preferred: Acute hospital case management experience. Required: RN . Must be currently licensed, certified, or registered to practice ... RN Case Manager Clinical Res Mgmt Full Time...patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient's resources and… more
    Tenet Healthcare (09/12/25)
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  • Disease Management Nurse - Remote

    Sharecare (Lansing, MI)
    …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting...with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the… more
    Sharecare (09/13/25)
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  • Consultant, Nurse Disability I

    Lincoln Financial (Lansing, MI)
    …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... **What we're looking for** Education * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state where… more
    Lincoln Financial (10/01/25)
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