• Utilization Management Nurse

    CenterWell (Lansing, MI)
    …community and help us put health first** 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 of a team that focuses on excellent… more
    CenterWell (11/22/25)
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  • Psych Graduate Nurse , At Risk Youth…

    Pine Rest Christian Mental Health Services (Grand Rapids, MI)
    …workplace. Principal Duties and Responsibilities: + Works in collaboration with an unrestricted Registered Nurse to provide care to person's served in a dyad ... 90-180 days. What Will You Do? As a Graduate Nurse ( RN ) at Pine Rest, you'll be...person's served centered, compassionate care. + Responsible for the utilization and continued review of patient care… more
    Pine Rest Christian Mental Health Services (10/25/25)
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  • RN Referral Management Coordinator…

    Henry Ford Health System (Troy, MI)
    …in Utilization or Quality Management, required. CERTIFICATIONS/LICENSURES REQUIRED: + Registered Nurse ( RN ) with current Michigan licensure. Additional ... RN REFERRAL MANAGEMENT COORDINATOR (VIRTUAL) - PRIOR AUTHORIZATIONS...looking to grow our Prior Authorization Team with experienced Registered Nurses! We are a team of Registered… more
    Henry Ford Health System (11/18/25)
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  • Denials Prevention Specialist, Clinician PRN

    Datavant (Lansing, MI)
    …with clinical knowledge and expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of...by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well… more
    Datavant (11/12/25)
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  • Nurse Manager- Plastic and Reconstructive…

    Henry Ford Health System (Detroit, MI)
    GENERAL SUMMARY: The Nursing Manager is a Registered Nurse who is accountable for leading, managing, developing, supervising, and evaluating the delivery of ... REQUIRED: Current licensure by the Michigan State Board of Nursing as a Registered Nurse . Current BLS or ACLS per Henry Ford Health policy.… more
    Henry Ford Health System (11/15/25)
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  • Disease Management Nurse - Remote

    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
    Sharecare (10/22/25)
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  • Payment Integrity Clinician

    Highmark Health (Lansing, MI)
    …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
    Highmark Health (11/14/25)
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  • Nurse Manager Surgical Services

    Corewell Health (Ludington, MI)
    …clinical nursing experience Required. + 1 year of relevant supervisory experience Required. + MI Registered Nurse ( RN ) Required. + AHA or ARC Basic Life ... supports a culture of safety and maintenance of interprofessional collaborative relationships. Nurse Managers in inpatient and outpatient units are REQUIRED to obtain… more
    Corewell Health (11/20/25)
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  • Regional Manager, Clinical Documentation Integrity…

    Trinity Health (Livonia, MI)
    …Nursing or the 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 3M CDI software. Analyzes data to determine...direct reports perform clinical validation as part of the review process and remain current on CDI strategies. Uses… more
    Trinity Health (10/08/25)
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  • Supervisor, Clinical Documentation Integrity (CDI)…

    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
    Trinity Health (08/26/25)
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