- 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
- Henry Ford Health System (Troy, MI)
- …trends to identify opportunities for improvement. Meet with appropriate HAP leadership to review utilization trends and reports. + Assist the Clinical Director, ... four (4) years of relevant related experience. + Minimum of two (2) years Utilization Management experience with emphasis on program management and… 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
- Trinity Health (Chelsea, MI)
- **Employment Type:** Part time **Shift:** Day Shift **Description:** **Registered Nurse ** **Case Manager** **Department:** Utilization Management ... population through the use of care plans, critical pathways, managed care, and utilization review processes and collaboration with all members of the health… more
- Trinity Health (Chelsea, MI)
- **Employment Type:** Part time **Shift:** Rotating Shift **Description:** **Registered Nurse ** **Case Manager** **Department:** Utilization Management ... population through the use of care plans, critical pathways, managed care, and utilization review processes and collaboration with all members of the health… more
- Sedgwick (Lansing, MI)
- …narcotic use contract with client. + Maintains accurate record system of pharmacy utilization review and complex pharmacy reviews to include cost savings, ... needed; performs complex review of cases to identify referral for case management as needed. + Participates in client meetings and phone calls to explain program… more
- Corewell Health (Royal Oak, MI)
- …you join our team at Corewell Health. Job Summary Responsible for the management of reporting APPs and APP supervisors including all activities related to direct ... and implementation performance evaluations, OPPE/FPPE, etc. Represents APPs to outside review services such as Joint Commission, American College of Surgeons etc.… more
- Erickson Living (Novi, MI)
- …clinical leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management /Safety ... clinical practice and processes in accordance with the Erickson Senior Living Management Policies and Procedures and nursing standards of practice. + Ownership of… more
- Humana (Lansing, MI)
- …and leadership during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), Medical Coverage ... **Desired Qualifications** + Master's degree in health-or business-related field + Utilization management experience (Commercial and/or Medicare) + Proven… more
- Trinity Health (Ann Arbor, MI)
- …managed care guidelines, best practice protocols, evidenced based care, and the utilization review processes. In partnership with the supervising physician the ... Education** : Master's Degree in clinical nursing from an accredited Nurse Practitioner Program with emphasis on area of certification/licensure. **NP Licensure**… more