- Integra Partners (Troy, MI)
- …experienced in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual will play a key ... UM program. Salary: $60,000.00/annual JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES The UM Nurse 's responsibilities include but are not limited to: + Perform… more
- Tenet Healthcare (Detroit, MI)
- …national standards for case management scope of services including: Utilization Management services supporting medical necessity and denial prevention ... potentially avoidable days Other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management Balances clinical and financial requirements and… more
- CVS Health (Lansing, MI)
- …all with heart, each and every day. **Position Summary** **This is a work at home position with working hours of one of the following shifts 8:00/8:30/9:00 AM - ... health outcomes by engaging telephonically with individuals living with diabetes. This nurse will guide members through actionable steps to close gaps in care,… more
- Tenet Healthcare (Detroit, MI)
- …national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention. Transition ... Registered Nurse (RN) - Case Manager - 2506003285 Description...q) and other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management : Balances clinical and financial requirements… more
- Veterans Affairs, Veterans Health Administration (Iron Mountain, MI)
- …of education, orientation, competencies and providing quality improvement and outcomes utilization consultation. VA offers a comprehensive total rewards package: VA ... Nurse Total Rewards Pay: Competitive salary, regular salary increases,...responsibilities that demonstrate leadership, experience and creative approaches to management of complex client care beyond the immediate practice… more
- Henry Ford Health System (Detroit, MI)
- …Proficiency with computers, electronic health records (EHR), database systems, and utilization review/case management documentation systems. + Knowledge of CMS, ... resources to optimize patient outcomes and promote efficient resource utilization . Key Responsibilities: Clinical Care Coordination: + Conduct comprehensive patient… more
- Evolent (Lansing, MI)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… 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 ... Be Doing:** + Practices and maintains the principles of utilization management and appeals management ...all employees have the following technical capability at their home : High speed internet over 10 Mbps and, specifically… more
- Corewell Health (Ludington, MI)
- …Key responsibilities include unit-based goal setting, program development, fiscal management , resource allocation, standards of care, policy and procedure ... supports a culture of safety and maintenance of interprofessional collaborative relationships. Nurse Managers in inpatient and outpatient units are REQUIRED to obtain… more
- Pine Rest Christian Mental Health Services (Grand Rapids, MI)
- …working together to help patients build functional skills for successful reintegration into home , school, and community settings. What Will You Do? As a Registered ... Nurse at Pine Rest, you'll be part of tight-knit...the teaching of persons' served families, and provides milieu management . Communicates with and educates persons' served families/significant others… more