• Nurse Audit Manager

    Humana (Lansing, MI)
    …where your clinical expertise and passion for accuracy will make a meaningful impact. As the Nurse Audit Manager , you will spearhead audit and validation ... relevant coding. + Identifies the root cause analysis of audit findings and submits recommendations for appropriate change management....skills to make an impact** **Required Qualifications** + Registered nurse (RN). + 5 or more years of clinical… more
    Humana (10/18/25)
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  • Utilization Management Nurse Supervisor

    Integra Partners (Troy, MI)
    The Utilization Management (UM) Nurse Supervisor is responsible for providing direct leadership and oversight to the UM nursing team. This role ensures team ... leadership duties, serving as both a mentor and performance manager for frontline staff. Salary: $75,000.00/Annually JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES… more
    Integra Partners (10/16/25)
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  • Medical Claim Review Nurse (RN)

    Molina Healthcare (Warren, MI)
    …**PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** Certified Clinical Coder, Certified Medical Audit Specialists, Certified Case Manager , Certified Professional ... to clinical experience + Documents clinical review summaries, bill audit findings and audit details in the database + Provides supporting documentation for… more
    Molina Healthcare (09/06/25)
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  • RN Clinical Appeals Nurse

    Molina Healthcare (Sterling Heights, MI)
    …following: + Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases… more
    Molina Healthcare (10/18/25)
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  • Pharmacy Program Manager

    CVS Health (Lansing, MI)
    …travel if a plan sponsor requests pharmacist attendance for an onsite visit/assessment/ audit . The Pharmacy Program Manager role includes: -Collaborate with an ... with heart, each and every day. The Pharmacy Program Manager is an individual contributor (non-people manager )...interdisciplinary care management team ( nurse case managers, medical directors, dietitians, social workers) to… more
    CVS Health (10/18/25)
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  • Manager of Patient Services Med Surg…

    Tenet Healthcare (Detroit, MI)
    Manager of Patient Services Med Surg Telemetry Full Time Days - 2506003229 Description : DMC Harper University Hospital has distinguished itself in surgery and ... and/or high-level professional/administrative exempt and Nursing supervisory personnel. The Manager Patient Services positions with patient care accountability, plan,… more
    Tenet Healthcare (09/26/25)
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  • Manager Patient Services Telemetry Full…

    Tenet Healthcare (Detroit, MI)
    Manager Patient Services Telemetry Full Time Days - 2506002938 Description : DMC Sinai-Grace Hospital is DMC's largest hospital, offering a comprehensive heart ... and/or high-level professional/administrative exempt and Nursing supervisory personnel. The Manager Patient Services positions with patient care accountability, plan,… more
    Tenet Healthcare (09/23/25)
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  • Manager of Patient Services SCI Full Time…

    Tenet Healthcare (Detroit, MI)
    Manager of Patient Services SCI Full Time Rotate - 2506003010 Description : DMC Rehabilitation Institute of Michigan is one of the nation's largest hospitals ... and/or high-level professional/administrative exempt and Nursing supervisory personnel. The Manager Patient Services positions with patient care accountability, plan,… more
    Tenet Healthcare (09/16/25)
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  • Manager Patient Services Pediatric ICU Full…

    Tenet Healthcare (Detroit, MI)
    Manager Patient Services Pediatric ICU Full Time Days - 2506002852 Description : Children's Hospital of Michiga n is an international leader in pediatric and ... and/or high-level professional/administrative exempt and Nursing supervisory personnel. The Manager Patient Services positions with patient care accountability, plan,… more
    Tenet Healthcare (09/13/25)
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  • Diagnosis Related Group Clinical Validation…

    Elevance Health (Dearborn, MI)
    …coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. + Draws on advanced ICD-10 coding expertise, mastery of ... clinical guidelines, and industry knowledge to substantiate conclusions. + Utilizes audit tools, auditing workflow systems and reference information to generate … more
    Elevance Health (09/23/25)
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