- Sharecare (Lansing, MI)
- …change techniques, the nurse helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is ... learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- CVS Health (Lansing, MI)
- …expert and provide oversight of the design, development, and deployment of Care Management , Utilization Management , Population Health, Health Equity and ... clinical excellence, achieving measurable health outcomes, and supporting quality and medical management in a highly matrixed environment. The CMO will also support… more
- Molina Healthcare (Sterling Heights, MI)
- …healthcare services team supporting one or more of the following functions: care management , utilization management , care transitions, long-term services and ... * Actively participates in the department auditing program to review , communicate findings and identify opportunities for improved quality...at least 2 years of managed care experienced in utilization management * Registered Nurse (RN) ONLY… more
- Highmark Health (Lansing, MI)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review , the incumbent participates as the...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… 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 ... substance use disorders. We are much more than just the third largest non-profit behavioral health system in the country, our 220-acre main campus, and our network… more
- Henry Ford Health System (Troy, MI)
- …relevant contractual requirements and issues to internal customers such as Utilization Management , Finance, Patient Billing, Administration, Legal, etc. 7. ... Payors and facilitate resolution of contracting and operational issues, ie billing, utilization review , credentialing site visits, notification of site closures… more
- AmeriHealth Caritas (Detroit, MI)
- …and accurate documentation of member interactions in the electronic care management platforms. + Monitor appropriate utilization and coordinate services ... health for medically fragile members with acute, chronic, medically complex, and/or behavioral health conditions and other health needs. Serves as the primary point… 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 ... are much more than just the third largest non-profit behavioral health system in the country, our 220-acre main...for dementia, depression and anxiety, as well as medication management . Families often suffer along with their older relatives,… more
- Corewell Health (Dearborn, MI)
- …sessions with eligible inpatients and Partial program patients and also may perform utilization review for this patient population + Provides discharge planning ... referral resources, bereavement support, adjustment counseling, facilitating guardianships and behavioral health concerns (including psychiatric transfers). + Conducts psychosocial… more
- Highmark Health (Lansing, MI)
- …stakeholder concerns. **Key Responsibilities:** + Lead and participate in Architecture Review Board processes, providing expert guidance on cloud-based solutions and ... solutions, networks, and infrastructure. Ensure optimal technology selection, resource utilization , and seamless integration. + Utilize modeling tools to develop… more
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