- Molina Healthcare (MI)
- …suite/applicable software program(s) proficiency. Preferred Qualifications * Utilization management , care management , behavioral health and/or long-term ... Job Duties * Performs audits of non-clinical staff in utilization management , care management , member...services and supports (LTSS) non-clinical review /auditing experience. To all current Molina employees: If you… more
- Behavioral Center of Michigan (Warren, MI)
- …and reporting of complex clinical data and supports the operations of Samaritan Behavioral Center. The Utilization Review Coordinator reviews the patient's ... Under general supervision, the Utilization Review Coordinator provides professional assessment, planning, coordination, implementation… more
- McLaren Health Care (Flint, MI)
- We are looking for a Utilization Management RN, to join us in leading our organization forward. McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of ... Inc. at https://www.mdwise.org/ . **Position** **Summary:** This position is responsible for utilization management functions. This includes but is not limited… more
- Molina Healthcare (Grand Rapids, MI)
- …Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health ... assists with implementing integrated Behavioral Health care management programs. **Knowledge/Skills/Abilities** Provides Psychiatric leadership for utilization… more
- Molina Healthcare (Ann Arbor, MI)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... with PEGA helpful. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT… more
- Molina Healthcare (Ann Arbor, 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 LICENSURE… more
- Elevance Health (Dearborn, MI)
- …to clients/ members. The medical director provides clinical expertise in all aspects of utilization review and case management . Provides input on the ... means that the medical director is directly involved in Utilization Management and Case Management ....state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Tenet Healthcare (Detroit, MI)
- …at hospital and department orientation is required. Department orientation includes review and instruction regarding Tenet Case Management and Compliance ... Clinical Social Worker Case Management Full Time Days - 2506003347 Description :...patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient's resources and… more
- Tenet Healthcare (Detroit, MI)
- …at hospital and department orientation is required. Department orientation includes review and instruction regarding Tenet Case Management and Compliance ... Clinical Social Worker Case Management Full Time Days - 2406004684 Description :...patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient's resources and… more
- Molina Healthcare (MI)
- …integrated) performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical ... an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high...years in one or more of the following areas: utilization management , case management , care… more