- Molina Healthcare (Ann Arbor, MI)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and...the specific programs supported by the plan such as Utilization Review , Medical Claims Review ,… more
- Prime Therapeutics (Lansing, MI)
- …of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. + ... drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description** Under supervision, is responsible for performing referral… more
- CVS Health (Lansing, MI)
- …You can have life-changing impact on our members, who are enrolled in Care Management and present with a wide range of complex health and social challenges. With ... exciting opportunity as we grow and expand our Care Management Programs to change lives in new markets across...who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current… 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 ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management … more
- Grace Health (Battle Creek, MI)
- Grace Health is seeking a Nurse Practitioner or Physician Assistant to join our expanding team. This position is a unique split role between providing healthcare ... (This list may not be all inclusive.) + Provides healthcare and health management of ambulatory pediatric population. + Provides direct patient care, case … more
- Corewell Health (Troy, MI)
- …Health. Full-time, Rotating Shifts GENERAL SUMMARY: Physician Assistants (PA) and Nurse Practitioners (NP) are graduates of an accredited educational program and ... + Free onsite parking at all of our campuses ESSENTIAL DUTIES: + Utilization of a high degree of discriminative judgement while providing medical management… more
- Pine Rest Christian Mental Health Services (Grand Rapids, MI)
- …staff assignments and promoting staff development. + Responsible for the utilization and continued review of patient care protocols, standards ... include treatment for dementia, depression and anxiety, as well as medication management . Families often suffer along with their older relatives, and part of… more
- Pine Rest Christian Mental Health Services (Grand Rapids, MI)
- …staff assignments and promoting staff development. + Responsible for the utilization and continued review of patient care protocols, standards ... to be a part of this incredible work. What Will You Do? As a Registered Nurse at Pine Rest, you'll be part of tight-knit team that believes in the healing power… more
- Corewell Health (Dearborn, MI)
- …insurance Free onsite parking at all of our campuses Essential Functions + Utilization of a high degree of discriminative judgement while providing medical ... management including assessment of medical and psychosocial status, comprehensive...recognized PA program that is accredited by the Accreditation Review Commission on Education for Physician Assistants and meet… more
- US Tech Solutions (MI)
- …with regulatory and accreditation guidelines and company policies and procedures **Skills:** + Utilization review + RN + Assure care + Clinical practice + ... + Through the use of clinical tools and information/data review , conducts comprehensive assessments of referred member's needs/eligibility and determines… more