- CenterWell (Lansing, MI)
- …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare… more
- McLaren Health Care (Pontiac, MI)
- **Department:** Utilization Management **Scheduled Bi-Weekly Hours:** 80 **Daily Work Times:** 11:00am to 7:00pm-On site **Position Summary:** Responsible for ... care environment _Preferred:_ + Bachelor's degree in nursing + Experience in utilization management /case management /clinical documentation, critical care, or… more
- Evolent (Lansing, MI)
- …As a Clinical Reviewer , Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- Evolent (Lansing, MI)
- …As a Clinical Reviewer , Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- Corewell Health (Grand Rapids, MI)
- …and continued stay. Educates medical staff/other health care professionals regarding utilization management and quality requirements. Makes recommendations and ... provides financial and utilization management information to other members of...patient centered care plan or related work + Registered Nurse in the State of Michigan Or Master Social… more
- Molina Healthcare (MI)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... Experience using PEGA **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT… more
- 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...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… 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 ... bonus available for qualified experienced candidates with current 2 years RN Case Management in a large acute care hospital setting. GENERAL SUMMARY: The Case… more
- Trinity Health (Grand Rapids, MI)
- …to learn regulatory and accrediting agency standards and regulations relative to utilization management . Knowledge of federal, state and local regulations ... prizes + Unlimited career growth opportunities **Position Summary:** The Nurse Navigator RN is a professional nurse ...affecting the utilization review program and payment as well… more
- Veterans Affairs, Veterans Health Administration (Ann Arbor, MI)
- …RN possesses intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation ... LTC Charles S. Kettles VA Medical Center is seeking a Full-Time Registered Nurse (RN) - Community Care aligned under Chief of Staff. Responsibilities The Community… more