- Humana (Lansing, MI)
- …licensure + Previous Medicare/Medicaid experience a plus + Previous experience in utilization management , case management , discharge planning and/or home ... community and help us put health first** The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care... depending on case findings. + Educates providers on utilization and medical management processes. + Enters… more
- Veterans Affairs, Veterans Health Administration (Detroit, MI)
- …and record relevant] patient information. Completed work should need only a general review by a registered nurse (RN) or physician (MD/DO) for appropriateness ... The PACT LPN is responsible for supporting and optimizing self-care management for PACT patients. This role involves exceptional collaboration and communication… 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
- 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
- Trinity Health (Howell, MI)
- …time **Shift:** Day Shift **Description:** **POSITION PURPOSE** + The Registered Nurse Case Manager assumes overall accountability for patients' discharge plans ... leadership role in achieving desired clinical, financial and resource utilization outcomes. + This is achieved by coordinating care...Friday. **WHAT YOU WILL DO** + The RN Registered Nurse Case manager is responsible for conducting a focused… more
- Henry Ford Health System (Troy, MI)
- …with our Medical Director. + To supervise the workflow and throughput of Utilization Management by evaluating and improving processes using innovative methods. + ... RN REGISTERED NURSE SUPERVISOR (VIRTUAL) - PRIOR AUTHORIZATIONS - 40...Nurses (5 and counting), and Administrative Professionals (3) that review medical necessity and medical criteria for all prior… 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