- CVS Health (Lansing, MI)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Tenet Healthcare (Detroit, MI)
- … Utilization Management Plan using data to drive hospital utilization performance improvement, c) ensures medical necessity review processes are completed ... case management scope of services including: * Utilization Management supporting medical necessity and denial...interpretation of department policies, in accordance with the DMC Utilization Review Plan. Identifies the need for… more
- Veterans Affairs, Veterans Health Administration (Iron Mountain, MI)
- …possesses intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation ... sustain an evidence-based-practice culture. Preferred Experience: 2 years of Registered Nurse and Case Management /Care coordination experience preferred. VA… 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 ... resources to optimize patient outcomes and promote efficient resource utilization . Key Responsibilities: Clinical Care Coordination: + Conduct comprehensive patient… more
- Henry Ford Health System (Detroit, MI)
- The Certified Registered Nurse Anesthetist (CRNA) Manager is a Certified Registered Nurse Anesthetist who ensures the delivery of safe anesthetic patient care in ... hospital/system leaders to develop a quality practice setting that supports professional nurse anesthesia practice and quality patient care. The CRNA Manager is… more
- Veterans Affairs, Veterans Health Administration (Ann Arbor, MI)
- …LTC Charles S. Kettles VA Medical Center is seeking a Full-Time Registered Nurse (RN) - Inpatient Community Living Center (CLC), aligned under Patient Care Services. ... Responsibilities Inpatient Staff Registered Nurse (RN) is responsible for providing competent, evidence-based care to assigned patients with oversight of licensed… more
- Molina Healthcare (Sterling Heights, MI)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT… more
- Highmark Health (Lansing, MI)
- …triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, ... Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or… more
- Molina Healthcare (Grand Rapids, MI)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support… more
- Pine Rest Christian Mental Health Services (Grand Rapids, MI)
- …needs and implements person's served centered, compassionate care. + Responsible for the utilization and continued review of patient care protocols, standards of ... 90-180 days. What Will You Do? As a Graduate Nurse (RN) at Pine Rest, you'll be part of...the teaching of persons' served families, and provides milieu management . Communicates with and educates persons' served families/significant others… more
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