- Cognizant (Lansing, MI)
- …Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,...Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan .… more
- Henry Ford Health System (Warren, MI)
- …Under minimal supervision, reviews and screens the appropriateness of services, the utilization of hospital resources and the quality of patient care rendered. ... and critical thinking to maximize reimbursement. EDUCATION/EXPERIENCE REQUIRED: + Registered Nurse required. + Minimum 3-5 years of clinical experience required. +… more
- CenterWell (Lansing, MI)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- State of Michigan (Lansing, MI)
- …program. To identify psychotropic medication regimens that require additional physician review according to policy, the Utilization Reviewer actively monitors ... Medicaid Utilization Analyst 12 - HSA Psychotropic Medication Oversight...Biweekly Location Lansing, MI Job Type Permanent Full Time Remote Employment Flexible/Hybrid Job Number 3901-26-HSA-MCMCS-001-EST Department Health and… more
- Molina Healthcare (MI)
- …managed care experience in the specific programs supported by the plan such as utilization review , medical claims review , long-term services and supports ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests are… more
- CVS Health (Lansing, MI)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... each and every day. **Position Summary** **This is a remote work from home role anywhere in the US...is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that… more
- Sharecare (Lansing, MI)
- … utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification ... more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- Highmark Health (Lansing, MI)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- Molina Healthcare (MI)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying ... cost-effective member care. The candidate must have Medicare Appeals and/or Utilization Management knowledge. Work hours are Monday-Friday 8:00am- 5:00pm PST. This… more
- Molina Healthcare (Warren, MI)
- JOB DESCRIPTION **Job Summary** The Care Review Clinician (RN) provides support for clinical member services review assessment processes. Responsible for ... Hospital experience. Candidates with MCO experience are highly preferred. The Care Review Clinician must be able to work independently in a high-volume environment.… more