- McLaren Health Care (Flint, MI)
- …member advocate with emphasis on education regarding managed care, disease management and PCP treatment plans. Monitors member's utilization patterns for ... We are looking for a Utilization Management RN, to join us...PHO and Managed Care functions including understanding of claims administration , including CPT-4 codes, revenue codes, HCPCS codes, DRGs,… more
- Veterans Affairs, Veterans Health Administration (Battle Creek, MI)
- …established protocols. Drug Information Maintains a current knowledge of therapeutics and disease management . Work Schedule: Monday - Friday, 0700-1700 (rotating ... the patient's drug regimen 3. Appropriateness of the route and method of administration 4. Degree of patient compliance with the prescribed drug regimen 5.… more
- Molina Healthcare (MI)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk adjustment, disease management ... Summary** Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and...resource management . + Develops and implements a Utilization Management program and action plan, which… more
- McLaren Health Care (Flint, MI)
- …member advocate with emphasis on education regarding managed care, disease management and PCP treatment plans. Monitors member's utilization patterns for ... members in assigned product lines, including case specific and disease management programs, including catastrophic cases. Works...BSN. + Two (2) years' experience in Managed Care Utilization Management , Medical Management , Case… more
- Evolent (Lansing, MI)
- …Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- CVS Health (MI)
- …Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible ... interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory standards while assessing… more
- Highmark Health (Lansing, MI)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... participates as the physician member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
- Corning Incorporated (Hemlock, MI)
- …leave, family building support, fitness, company-paid life insurance, disability, and disease management programs. + Company-wide bonuses and long-term ... and time management skills. + Great computer skills and EMR utilization **Experiences/Education - Desired** + Certified Occupational Health Nurse (COHN | COHN-S)… more
- Option Care Health (Farmington Hills, MI)
- …revenue, margin, and referral growth. Plays an active role in account management and business development efforts with team, engaging customers and both modeling ... + coach and provide developmental feedback. + Maintain strong relationships with branch management to ensure sales efforts are supported by branch service and sales… more
- Allegan County (Allegan, MI)
- …indicators such as environmentally-caused illnesses, immunization levels, and communicable disease occurrence in order to identify problems that threaten public ... makes appropriate referrals, utilizing resources + Provides comprehensive case management and coordinates services provided through a multidisciplinary approach… more
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