- McLaren Health Care (Petoskey, MI)
- …for new supplies and minor equipment purchases. + Fosters smoothly running case management and utilization review services and processes through timely ... attainment of objectives through the selection, development, training, and evaluation of case management and utilization review services staff. + Maintains… more
- Humana (Lansing, MI)
- …leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse , with a focus on our 5+ million Medicare ... members. The Director, Physician leadership will lead Medical Directors performing utilization management for inpatient authorizations training medical director… more
- University of Michigan (Ann Arbor, MI)
- …as Allscripts + Participate in venues to reduce barriers to discharge ** Utilization Review and Utilization Management ** + Conduct clinical review on ... position is unique in that it combines clinical/quality considerations with regulatory/financial/ utilization review demands. The position creates a balance… more
- Molina Healthcare (Warren, MI)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical… more
- Corewell Health (Royal Oak, MI)
- …discharge planning of all hospitalized patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; and/or ... relevant experience Three to five years' experience in care management , utilization review , home care..., home care and/or discharge planning. Preferred + Registered Nurse (RN) - State of Michigan License Upon Hire… more
- Corewell Health (Dearborn, MI)
- …discharge planning of all hospitalized patients. + Identifies patients that need care management services (ie utilization review ; care coordination; and/or ... relevant experience Three to five years' experience in care management , utilization review , home care..., home care and/or discharge planning. Preferred + Registered Nurse (RN) - State of Michigan Upon Hire required… more
- Prime Healthcare (Port Huron, MI)
- …Provides leadership and supervision to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and ... positive and supportive work environment. Responsibilities The Regional Director of Case Management will be responsible for the operations of the Case Management… more
- Molina Healthcare (Grand Rapids, MI)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Molina Healthcare (Detroit, MI)
- …role must complete courses required to obtain licensure in all states. + Utilization Review Lead responsibilities also include but not limited to, collaborate ... Experience** 3-5 years clinical practice with managed care, hospital nursing, utilization and/or care management experience. **Preferred License, Certification,… more
- Sedgwick (Lansing, MI)
- …(10) of related experience required to include one (1) to three (3) years utilization review experience and three (3) years clinical quality control. **Skills & ... the following: + Conducting reviews on cases where the nurse is seeking treatment plan clarification, claim denial, disability...+ Knowledge of ADAA and FMLA + Knowledge of utilization review procedures + Knowledge of clinical… more