- 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, ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/medical reviews of previously denied… more
- Molina Healthcare (Warren, 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
- Corewell Health (Farmington Hills, MI)
- …care management, utilization review , home care and/or discharge planning. Preferred + Registered Nurse ( RN ) - State of Michigan Upon Hire required + ... patients. + Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). +… more
- Corewell Health (Royal Oak, MI)
- …management, utilization review , home care and/or discharge planning. Preferred + Registered Nurse ( RN ) - State of Michigan License Upon Hire required ... patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). 2.… more
- Trinity Health (Chelsea, MI)
- …Type:** Part time **Shift:** Day Shift **Description:** ** Registered Nurse ** **Case Manager** **Department:** Utilization Management **Location:** Chelsea, ... + Tuition Reimbursement **Position Purpose:** Exceptional opportunity for a Registered Nurse Case Manager to support our...use of care plans, critical pathways, managed care, and utilization review processes and collaboration with all… more
- Trinity Health (Chelsea, MI)
- …Part time **Shift:** Rotating Shift **Description:** ** Registered Nurse ** **Case Manager** **Department:** Utilization Management **Location:** Chelsea, ... + Tuition Reimbursement **Position Purpose:** Exceptional opportunity for a Registered Nurse Case Manager to support our...use of care plans, critical pathways, managed care, and utilization review processes and collaboration with all… more
- Molina Healthcare (Detroit, MI)
- …Care Plan compliance. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Licensed Registered Nurse ( RN ), Licensed Vocational Nurse ... role must complete courses required to obtain licensure in all states. + Utilization Review Lead responsibilities also include but not limited to, collaborate… 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 ... RN CASE MANAGER: (Care Management- D. Dan and...+ Participate in venues to reduce barriers to discharge ** Utilization Review and Utilization Management**… more
- Evolent (Lansing, MI)
- …Registered Nurse + Associate or Bachelors in Nursing (Must be a Registered Nurse ) + Experience as an RN in a Pain MNGT setting is preferred. + Strong ... it. **What You'll Be Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way… more
- Erickson Living (Novi, MI)
- …leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management/Safety (PI/RM/S) Committee ... (skilled nursing, long term care, assisted living or hospital) is required. + Current Registered Nurse license for the state in which they operate. + Current… more