- 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...required by state or federal guidance + Licensed physician, registered nurse or holds an undergraduate degree… more
- Munson Healthcare (Traverse City, MI)
- …degree in nursing (must have RN license or social work license). If Registered Nurse , must be licensed to practice in Michigan. Also, for those hired ... facilitate the progress of completing complex post-acute services + Interface with utilization review specialists to stay current on patient's eligibility for… more
- Prime Therapeutics (Lansing, MI)
- …Patient Programs. **Minimum Qualifications** + Associates - Nursing + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - ... for work visa or residency sponsorship **Additional Qualifications** + Registered Nurse ( RN ). + Oncology...Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. +… more
- McLaren Health Care (Petoskey, MI)
- …Associate degree in healthcare related field + Two years of case management or utilization review experience + Three years of recent experience doing third party ... Responsible for providing assistance to the RN and SW Care Managers in the coordination of discharge and transition plans, as well as, performing clerical functions… more
- Molina Healthcare (MI)
- …identifying opportunities for improvement. **JOB QUALIFICATIONS** **Required Education** + Registered Nurse or equivalent combination of Licensed Vocational ... performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical necessity,... Nurse (LVN) or Licensed Practical Nurse (LPN) with experience in lieu of … 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
- US Tech Solutions (MI)
- …compliance with regulatory and accreditation guidelines and company policies and procedures **Skills:** + Utilization review + RN + Assure care + Clinical ... + Through the use of clinical tools and information/data review , conducts comprehensive assessments of referred member's needs/eligibility and determines… more
- Highmark Health (Lansing, MI)
- …**Preferred** + 5 years of experience with communications + 3 years of experience in Utilization Review + 3 years of experience in Account Support + 1 year ... **Required** + None **Preferred** + PA clinical licensure/certifications such as RN , RD, Pharmacist **Language (Other than English):** None **Travel Requirement:**… more
- CVS Health (Lansing, MI)
- …during shift times are not permitted. **Required Qualifications** + Active unrestricted state Registered Nurse licensure in state of residence required. + 1+ ... high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant - Oncology...year Oncology and Transplant UM, concurrent review or prior authorization + 3+ years acute clinical… more
- Molina Healthcare (Detroit, MI)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary… more
Recent Searches
- rn nurse practitioner (United States)
- Senior Python Engineer Remote (United States)
- Windows Linux Systems Admin (United States)
- education assessment accountability (United States)
Recent Jobs
-
Lead Operations Technician, Supervisor
- Merck & Co. (Baton Rouge, LA)
-
Respiratory Therapist 2
- Rush University Medical Center (Chicago, IL)
-
Psychiatry Area Sales Manager
- Lundbeck (Indianapolis, IN)
-
Associate Director, Marketing
- Merck & Co. (Montgomery County, PA)