- YesCare Corp (Port Huron, MI)
- …measures including sentinel event review + Actively participant of the Utilization Review process and follow proper procedures. **YesCare Benefits** (only ... and paraprofessional staff. + Ensure and provide on-call services. + Annually review and approve clinical protocols, policies and procedures, and medical disaster… more
- Trinity Health (Livonia, MI)
- …specialists (CDS) to enhance clinical and coding skill sets and optimal utilization of the 3M CDI software. Responsible for scheduling and work assignments ... direct reports perform clinical validation as part of the review process and remain current on CDI strategies. Maintains...Must possess one of the below: + Current Registered Nurse (RN) License + Registered Health Information Administrator (RHIA)… more
- Corewell Health (St. Joseph, MI)
- …in Wound, Ostomy and Continence Nursing. This includes effective utilization of workforce, equipment, and supplies. Develops interdisciplinary relationships to ... improvement plans to correct variances. + Participates in the development and review of policies, procedures and guidelines related to wound, ostomy and continence… more
- Munson Healthcare (Traverse City, MI)
- …Min/Preferred Certification, Licensure, Registration Comments Minimum Licensed as a Registered Nurse in the State of Michigan OTHER REQUIREMENTS . For those ... according to accepted standards of clinical nursing practice. b. Assists in the utilization of the PCSS database to ensure appropriate staffing ratios. c. Promotes… more
- Molina Healthcare (Detroit, MI)
- **Job Summary** **_For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of KENTUCKY or have a compact license._** Provides ... claims data to ensure appropriate payment levels, optimize resource utilization , and maintain compliance with state and federal laws....focus on promoting the quality, accuracy, and efficiency of review services. + Serve as a resource and subject… more
- University of Michigan (Ann Arbor, MI)
- …process. + Coordinate and expedite patient transfer to inpatient unit by utilization of MiChart and paging in collaboration with ABCC, nursing (inpatient/ED), and ... ensuring continuity of care for ED patients. + Monitor nurse call system responding to patient requests for assistance...posted for a minimum of seven calendar days. The review and selection process may begin as early as… more
- AmeriHealth Caritas (Southfield, MI)
- …plan of care, referrals, and evaluation of the effectiveness of the plan + Review medication list and educate Members with pharmacy needs, and counsel on side ... ACFC electronic care management platforms where applicable + Monitor appropriate utilization and coordinate services with other payer sources, make appropriate… more
- University of Michigan (Ann Arbor, MI)
- …and under a practice agreement with Interventional Radiologists. This includes utilization of image guided modalities such as ultrasound, fluoroscopy, CT, and ... consult requests and performs consults to include documented pre-procedure case review , patient evaluations, and pre-procedure order entry. + Serves as primary… more
- Corewell Health (Grand Rapids, MI)
- …Also ensures continuity and coordination of services with appropriate utilization of resources. Responsible for stakeholder management across collaboration within ... for specific requirements as they are updated annually. + QI Measure Review . ACQRs are responsible for reviewing site measure performance and determining data… more
- Elara Caring (Ludington, MI)
- …Identifies and reports potential payment/coverage problems. + Supervises and coordinates utilization review activities. + Participates in strategic development ... Key Accounts, including participation in weekly, monthly, and quarterly review meetings, as needed. + Ensures accuracy of all...by state or federal guidance + Licensed physician, registered nurse or holds an undergraduate degree + 3+ years… more