• Appeals Audit Specialist - McLaren Careers

    McLaren Health Care (Mount Pleasant, MI)
    …6. Provides support in response, tracking and completion of all payer audit /denial/appeal activity to ensure that timelines in the process are met, including ... sessions to maintain competency and knowledge of regulations in denials, utilization management, care management, clinical documentation, and leadership skills and… more
    McLaren Health Care (11/11/25)
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  • Medical Review Nurse (RN)- Remote

    Molina Healthcare (Sterling Heights, MI)
    …ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. + ... of payment decisions. + Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/appeals. + Provides training and… more
    Molina Healthcare (01/09/26)
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  • Organizational Quality Nurse Specialist

    Hospice of Michigan (Ann Arbor, MI)
    …Additional Development Requests (ADRs), Comprehensive Error Rate Testing (CERT), Recovery Audit Contractor (RAC) etc., requests and participates in appeal processes. ... of Service: courtesy, acknowledgement, response and empathy. Qualifications: + Registered Nurse with a baccalaureate degree in nursing, preferably a Master's Degree… more
    Hospice of Michigan (12/10/25)
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  • Director - Case Management

    Tenet Healthcare (Detroit, MI)
    …and is determined by employment status Summary Description Oversees hospital utilization performance improvement and operational management of the site Case ... Management Department to promote effective utilization of hospital resources, ensure processes support appropriate reimbursement for services rendered, support… more
    Tenet Healthcare (12/02/25)
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  • Medical Management Educator

    Corewell Health (Grand Rapids, MI)
    Registered Nurse OR Social Worker Scope of work: In conjunction with Medical Management leadership, coordinates the educational plan for the Behavioral Health, Care ... Management, and Utilization Management departments. Stakeholders include staff, physicians, department leadership, and third-party vendors. Uses specific age and… more
    Corewell Health (12/19/25)
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