- 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
- Molina Healthcare (Sterling Heights, MI)
- …and at least 2 years of managed care experienced in utilization management * Registered Nurse ( RN ) ONLY if required by state contract, regulation or ... skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse ( RN ). License must be active and… more
- Tenet Healthcare (Commerce Township, MI)
- …discharge planning experience. Preferred: Acute hospital case management experience. Required: RN . Must be currently licensed, certified, or registered to ... RN Case Manager Clinical Res Mgmt Full Time...patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient's resources and… more
- Evolent (Lansing, MI)
- …**Qualifications Required and Preferred:** + Current, unrestricted state licensure as a Registered Nurse - **Required** + Associate or Bachelors in Nursing (Must ... , you will be a key member of the utilization management team. We can offer you a meaningful way...be a Registered Nurse ) - **Required** + You must be… more
- AmeriHealth Caritas (Detroit, MI)
- …required. + Bachelor of Science in Nursing preferred. + Current, active, and unrestricted Registered Nurse licensure. + 3 or more years of clinical experience at ... care, referrals, and evaluation of the plan's effectiveness. + Review the medication list, educate members on pharmacy needs,...the bedside (as a Registered Nurse ) working with medically fragile patients… more
- Sharecare (Lansing, MI)
- …to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they ... utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification… more
- Trinity Health (Livonia, MI)
- …or Nursing or equivalent in experience. Must possess one of the below: + Current Registered Nurse ( RN ) License + Registered Health Information ... to enhance clinical and coding skill sets and optimal utilization of the 3M CDI software. Responsible for scheduling...direct reports perform clinical validation as part of the review process and remain current on CDI strategies. Maintains… more
- Munson Healthcare (Traverse City, MI)
- …REGISTRATION Min/Preferred Certification, Licensure, Registration Comments Minimum Licensed as a Registered Nurse in the State of Michigan OTHER REQUIREMENTS ... according to accepted standards of clinical nursing practice. b. Assists in the utilization of the PCSS database to ensure appropriate staffing ratios. c. Promotes… more