- Molina Healthcare (Sterling Heights, MI)
- …**JOB QUALIFICATIONS** **Required Education** Any of the following: Licensed Vocational Nurse ( LVN ) or Licensed Practical Nurse (LPN) Program OR a bachelor's or ... field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3 years of hospital or medical clinic… more
- Tenet Healthcare (Detroit, MI)
- …to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patients resources and right to ... national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention. Transition Management… more
- Veterans Affairs, Veterans Health Administration (Detroit, MI)
- …or health coaching. Responsible for completing focused data collection by the utilization of all clinical reminders as outlined in the clinical guidelines standing ... completed work may require routine or detailed higher level review depending upon the complexity of the duties involved....Six months of qualifying experience as an LPN or LVN ; or (b) Graduation from an approved school (which… more
- Molina Healthcare (Ann Arbor, MI)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies and… more
- Molina Healthcare (Detroit, MI)
- …role must complete courses required to obtain licensure in all states. + Utilization Review Lead responsibilities also include but not limited to, collaborate ... timely completion. + Actively participates in the Department auditing program to review and communicate findings with staff and identify opportunities for improved… more
- Tenet Healthcare (Detroit, MI)
- …to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient's resources and right to ... leading and/or facilitating multi-disciplinary patient care conferences including Complex Case Review , f) making appropriate referrals to other departments, g )… more