- McLaren Health Care (Pontiac, MI)
- …12. Performs other duties as assigned. #LI-AK1 _Required_ + State licensure as a Registered Nurse ( RN ) + Bachelor's degree in nursing from accredited ... **Department:** Utilization Management **Scheduled Bi-Weekly Hours:** 80 **Daily Work...on all patients reviewed in the ED. Conducts initial review using InterQual, MCG and other tools, assists provider… more
- Veterans Affairs, Veterans Health Administration (Ann Arbor, MI)
- Summary The LTC Charles S. Kettles VA Medical Center is seeking a Full-Time Registered Nurse ( RN ) - Community Care aligned under Chief of Staff. ... Responsibilities The Community Care (CC) Registered Nurse ( RN ) is responsible...intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation… more
- Henry Ford Health System (Detroit, MI)
- …community partners to support patient needs beyond the hospital setting. Qualifications: + Registered Nurse ( RN ) with active licensure + Minimum [number] ... and the ability to work in a fast-paced environment. Licenses and Certifications: + Registered Nurse ( RN ) with a valid, unrestricted State of Michigan… more
- Pine Rest Christian Mental Health Services (Grand Rapids, MI)
- …availability will be variable based on staffing needs. What Will You Do? As a Registered Nurse at Pine Rest, you'll be part of tight-knit team that believes ... ultimately help participants live in a more independent setting. RN Shifts available for pick up are 12 hours,...assignments and promoting staff development. + Responsible for the utilization and continued review of patient care… more
- Pine Rest Christian Mental Health Services (Grand Rapids, MI)
- …Pine Rest (https://www.pinerest.org/inpatient-services/services/older-adult-inpatient-services/) What Will You Do? As a Registered Nurse at Pine Rest, you'll be ... the healing power of your expertise and compassion. An RN is responsible and accountable to perform the nursing...assignments and promoting staff development. + Responsible for the utilization and continued review of patient care… more
- Evolent (Lansing, MI)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Molina Healthcare (MI)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual… more
- CenterWell (Lansing, MI)
- …and the healthcare industry as a whole. Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part...skills to make an impact** **Role Essentials** + Active RN license + Possession of or ability to obtain… more
- Corewell Health (Grand Rapids, MI)
- … management, discharge planning designing patient centered care plan or related work + Registered Nurse in the State of Michigan Or Master Social Worker from ... continued stay. Educates medical staff/other health care professionals regarding utilization management and quality requirements. Makes recommendations and provides… more
- Trinity Health (Grand Rapids, MI)
- …utilization management. Knowledge of federal, state and local regulations affecting the utilization review program and payment as well as current knowledge of ... prizes + Unlimited career growth opportunities **Position Summary:** The Nurse Navigator RN is a professional ...third-party payor programs, requirements and criteria utilized. (For utilization review nurses only) **Our Commitment** Rooted… more