• Utilization Management Registered Nurse,…

    McLaren Health Care (Flint, MI)
    …for utilization management functions. This includes but is not limited to review and authorization of services, utilization of medical policy, utilization ... Group (MIG) is a fully owned subsidiary of McLaren Health Care Corporation and is the parent company of...of standard screening techniques, and utilization of behavioral change techniques. Works with the PCP, the member… more
    McLaren Health Care (10/01/25)
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  • Medical Director, Behavioral Health…

    Molina Healthcare (Grand Rapids, MI)
    **JOB DESCRIPTION** **Job Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management and case management ... and chemical dependency services and assists with implementing integrated Behavioral Health care management programs. **Knowledge/Skills/Abilities** Provides… more
    Molina Healthcare (09/13/25)
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  • Care Review Clinician, Prior Authorization

    Molina Healthcare (Ann Arbor, MI)
    …degree in a healthcare field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3 ... good standing, such as LCSW, LPCC or LMFT (for Behavioral Health Care Review Clinicians...in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management… more
    Molina Healthcare (09/18/25)
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  • Care Review Clinician, PA (RN)

    Molina Healthcare (Ann Arbor, MI)
    …plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG… more
    Molina Healthcare (09/05/25)
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  • Chief Medical Officer--Aetna Better Health…

    CVS Health (Lansing, MI)
    …imperatives. 4. Provide clinical expertise to shape the integrative model of physical, behavioral , and health related resource needs to support holistic care and ... competitive business advantage by supporting the plan goals. 2. Review , interpret and analyze data and trends at State...of the design, development, and deployment of Care Management, Utilization Management, Population Health , Health … more
    CVS Health (09/04/25)
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  • National Accounts Medical Director

    Elevance Health (Dearborn, MI)
    …clients/ members. The medical director provides clinical expertise in all aspects of utilization review and case management. Provides input on the clinical ... state or territory of the United States when conducting utilization review or an appeals consideration and...For Health Solutions and Carelon organizations (including behavioral health ) only, minimum of 5 years… more
    Elevance Health (09/23/25)
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  • Psych RN, Co-Occurring Substance Use & Mental…

    Pine Rest Christian Mental Health Services (Grand Rapids, MI)
    …and 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 ... a state-of-the-art psychiatric urgent care center and a soon-to-be-built pediatric behavioral health center, outpatient, inpatient, partial hospitalization (day… more
    Pine Rest Christian Mental Health Services (09/23/25)
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  • Part-Time Weekend Medical Director (Remote)

    Highmark Health (Lansing, MI)
    …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most… more
    Highmark Health (09/11/25)
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  • Insurance Contract Consultant/Full Time/Hybrid

    Henry Ford Health System (Troy, MI)
    …of contractual provisions and rates on behalf of HFHS Hospitals, Medical Group, Behavioral Health Services and other business units. 1. Independently evaluate ... Payors and facilitate resolution of contracting and operational issues, ie billing, utilization review , credentialing site visits, notification of site closures… more
    Henry Ford Health System (08/22/25)
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  • Clinical Social Worker MSW PRN

    Corewell Health (Dearborn, MI)
    …referral resources, bereavement support, adjustment counseling, facilitating guardianships and behavioral health concerns (including psychiatric transfers). + ... inpatients and Partial program patients and also may perform utilization review for this patient population +...and innovation in the fields of orthopedics, neurosciences, women's health , heart & vascular, and cancer care. QUALIFICATIONS: +… more
    Corewell Health (09/30/25)
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