• RN Care Coordinator

    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 (11/24/25)
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  • Medical Director (NV)

    Molina Healthcare (Detroit, MI)
    …learn new programs. Preferred Qualifications * Experience with utilization /quality program management . * Managed care experience. * Peer review experience. * ... of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies… more
    Molina Healthcare (11/21/25)
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  • Multi-Site Director Case Management

    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
    Prime Healthcare (10/13/25)
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  • Medical Director

    Molina Healthcare (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 (10/17/25)
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  • RN Clinical Manager

    CenterWell (Grand Rapids, MI)
    …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...and reliable transportation. + Two years as a Registered Nurse with at least one-year of management … more
    CenterWell (10/31/25)
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  • RN Clinical Manager

    CenterWell (Portage, MI)
    …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...and reliable transportation. + Two years as a Registered Nurse with at least one-year of management … more
    CenterWell (09/06/25)
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  • Medical Director

    Corewell Health (Grand Rapids, MI)
    …of medical management + Provide clinical oversight to nurse case management and utilization management . + Promote and advocate for patient-centered ... of the guiding principles will be demonstrated through applications of evidence-based utilization review process and application of sound clinical judgement. The… more
    Corewell Health (10/25/25)
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  • RN Case Manager

    Trinity Health (Livonia, MI)
    …of clinical experience in nursing and recent (within 2 year) experience in utilization review / management /discharge planning or case management . Current ... Care Team as a** **Case Manager** **in the Case Management Department awaits YOU ** **_Trinity Health Livonia_** is...criteria. Knowledge of federal, state and local regulation affecting utilization review programs and payments. Knowledge of… more
    Trinity Health (11/08/25)
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  • Payment Integrity Clinician

    Highmark Health (Lansing, MI)
    …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
    Highmark Health (11/14/25)
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  • Denials Prevention Specialist, Clinician PRN

    Datavant (Lansing, MI)
    …healthcare. The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical ... letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted providers +...management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in… more
    Datavant (11/12/25)
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