• Medicaid Utilization Analyst 12 - HSA…

    State of Michigan (Lansing, MI)
    …requirement. Medicaid Utilization Analyst 12 Two years of experience as a Registered Nurse P11 or equivalent may be substituted for the education ... To identify psychotropic medication regimens that require additional physician review according to policy, the Utilization Reviewer...OR at least two years of experience as a Registered Nurse P11 or equivalent. If so,… more
    State of Michigan (11/20/25)
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  • Care Review Clinician ( RN )

    Molina Healthcare (Grand Rapids, MI)
    For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
    Molina Healthcare (11/23/25)
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  • Clinical Director, Health Plan Operations…

    McLaren Health Care (Flint, MI)
    …to meet organizational goals. Assumes responsibility for the clinical administrative aspects of utilization review and case management . Integrates medical ... and procedures as well as documentation of the case management and utilization management processes....in Nursing, health care or business-related field + Valid RN License in state doing business in + Ten… more
    McLaren Health Care (11/10/25)
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  • RN Care Review Clinician Remote

    Molina Healthcare (Warren, MI)
    …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The Care Review Clinician ( RN ) provides support for...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required… more
    Molina Healthcare (11/21/25)
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  • RN UM Care Review Clinician Remote

    Molina Healthcare (Ann Arbor, MI)
    …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required… more
    Molina Healthcare (11/13/25)
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  • Utilization Management Nurse

    CenterWell (Lansing, MI)
    … RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous… more
    CenterWell (11/22/25)
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  • Care Review Clinician ( RN )

    Molina Healthcare (Sterling Heights, MI)
    …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At… more
    Molina Healthcare (11/21/25)
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  • RN Referral Management Coordinator…

    Henry Ford Health System (Troy, MI)
    … Utilization or Quality Management , required. CERTIFICATIONS/LICENSURES REQUIRED: + Registered Nurse ( RN ) with current Michigan licensure. Additional ... RN REFERRAL MANAGEMENT COORDINATOR (VIRTUAL) -...the time of the denial and distributes to the Utilization Management Services staff for processing. +… more
    Henry Ford Health System (11/18/25)
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  • RN Clinical Manager

    CenterWell (Grand Rapids, 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 (10/31/25)
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  • RN UM Clinical Appeals Nurse Remote

    Molina Healthcare (MI)
    …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal...officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports… more
    Molina Healthcare (11/14/25)
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