- US Tech Solutions (MI)
- …with regulatory and accreditation guidelines and company policies and procedures **Skills:** + Utilization review + RN + Assure care + Clinical practice + ... + Through the use of clinical tools and information/data review , conducts comprehensive assessments of referred member's needs/eligibility and determines… more
- Fresenius Medical Center (Romulus, MI)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
- Molina Healthcare (Sterling Heights, MI)
- …State Plan. **JOB QUALIFICATIONS** **Required Education** Any of the following: Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR a ... 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
- Molina Healthcare (Detroit, MI)
- …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical… more
- Corewell Health (Royal Oak, MI)
- …patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). 2. ... experience Three to five years' experience in care management, utilization review , home care and/or discharge planning...., home care and/or discharge planning. Preferred + Registered Nurse (RN) - State of Michigan License Upon Hire… more
- Corewell Health (Dearborn, MI)
- …patients. + Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). + ... experience Three to five years' experience in care management, utilization review , home care and/or discharge planning...., home care and/or discharge planning. Preferred + Registered Nurse (RN) - State of Michigan Upon Hire required… more
- University of Michigan (Ann Arbor, MI)
- …position is unique in that it combines clinical/quality considerations with regulatory/financial/ utilization review demands. The position creates a balance ... software, such as Allscripts + Participate in venues to reduce barriers to discharge ** Utilization Review and Utilization Management** + Conduct clinical … more
- Molina Healthcare (Detroit, MI)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
- McLaren Health Care (Petoskey, MI)
- …and minor equipment purchases. + Fosters smoothly running case management and utilization review services and processes through timely and effective resolution ... selection, development, training, and evaluation of case management and utilization review services staff. + Maintains professional...a health-related field + State license as a Registered Nurse (RN) + Four years of professional experience in… 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