- 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
- CenterWell (Lansing, MI)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- 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
- Henry Ford Health System (Troy, MI)
- …required. + Bachelor of Science Nursing required OR four (4) years Case Management / Appeal/ Utilization Management experience in lieu of bachelor's degree. ... Under minimal supervision, reviews and screens the appropriateness of services, the utilization of hospital resources and the quality of patient care rendered.… 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
- Sedgwick (Lansing, MI)
- …Six (6) years of related line of business experience in telephonic case management (TCM) and/or utilization review or equivalent combination of ... Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Quality Review Nurse **PRIMARY PURPOSE** : To monitor team and colleague technical… more
- Tenet Healthcare (Detroit, MI)
- …national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention. Transition ... underutilization, q) and other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management : Balances clinical and financial requirements and… 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