- Fresenius Medical Center (Mount Pleasant, MI)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Tenet Healthcare (Detroit, MI)
- Registered Nurse Case Manager Contingent Days - 2506002318 Description : DMC Sinai-Grace Hospital is DMC's largest hospital, offering a comprehensive heart ... hospitals and physicians throughout the nation. Job Description: The RN Case Manager is responsible to facilitate care along...management experience preferred. 3. License to practice as a Registered Nurse in the State of Michigan.… 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...required by state or federal guidance + Licensed physician, registered nurse or holds an undergraduate degree… 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
- Prime Healthcare (Port Huron, MI)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. Assesses ... computer skills. Preferred qualifications: 1. Healthcare professional licensure required as Registered Nurse , Licensed Clinical Social Worker (LCSW), or Licensed… more
- Henry Ford Health System (Troy, MI)
- …trends to identify opportunities for improvement. Meet with appropriate HAP leadership to review utilization trends and reports. + Assist the Clinical Director, ... by the Clinical Director, Appeals and Grievance. Education and Experience Required: + Registered Nurse with current Michigan licensure. + Bachelor's Degree in… more
- Prime Therapeutics (Lansing, MI)
- …Patient Programs. **Education & Experience** + Associates - Nursing + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - ... for work visa or residency sponsorship. **Additional Qualifications** + Registered Nurse ( RN ). + 5...Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. +… more
- Evolent (Lansing, MI)
- …quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on ... + Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current,… more
- Trinity Health (Ann Arbor, MI)
- …managed care guidelines, best practice protocols, evidenced based care, and the utilization review processes. In partnership with the supervising physician, the ... Practitioner Program with emphasis on area of certification/licensure. **NP Licensure** : Current Registered Nurse and Acute Care Nurse Practitioner license… more
- Trinity Health (Ann Arbor, MI)
- …managed care guidelines, best practice protocols, evidenced based care, and the utilization review processes. In partnership with the supervising physician the ... Practitioner Program with emphasis on area of certification/licensure. **NP Licensure** : Current Registered Nurse and Nurse Practitioner license in the… more