• Medical Director Aetna Duals Center of Excellence

    CVS Health (Lansing, MI)
    …to cover urgent cases can be done from your laptop. **Fundamental Components:** * Utilization management - The medical director will perform concurrent and prior ... Multiple state licensure a plus. **Preferred Qualifications:** Previous Experience in Utilization Management / Claims Determination with another Health Plan… more
    CVS Health (11/13/25)
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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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  • RN -Youth Neurodevelopmental Disorders

    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
    Pine Rest Christian Mental Health Services (11/08/25)
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  • Medical Director-Geriatrician Specialty Strongly…

    Elevance Health (MI)
    …and overseeing clinical/non-clinical activities. Will also be responsible for utilization review / management . May be responsible for ... state or territory of the United States when conducting utilization review or an appeals consideration and...background. + For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience… more
    Elevance Health (11/12/25)
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  • Dental Network Service Representative

    Highmark Health (Lansing, MI)
    …designs, competitive position, product development, network options, strategic partnerships, utilization review , local/national client demographics and dentist ... terms through regular on-site audits. Apply an active role in network management , training, monitoring and enforcement of company policies and procedures while… more
    Highmark Health (11/14/25)
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  • Pharmacy Product Director - Medicare DSNP

    Highmark Health (Lansing, MI)
    …of internal clinical and value-based evaluation committees that drive formulary and utilization management functions. + Participate in product specific Pharmacy ... of implemented initiatives. + Lead product based pharmacy trend management discussions with internal partners including senior executives. +...and Therapeutics Committees and Drug Utilization Review (DUR) Committees as necessary or… more
    Highmark Health (11/14/25)
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  • Psych RN, Geriatric Inpatient

    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
    Pine Rest Christian Mental Health Services (11/08/25)
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  • Clinical Social Worker MSW PRN

    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
    Corewell Health (09/30/25)
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  • Psych Graduate Nurse, At Risk Youth Residential

    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 ... 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
    Pine Rest Christian Mental Health Services (10/25/25)
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  • Psych RN, Inpatient Float

    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
    Pine Rest Christian Mental Health Services (09/23/25)
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