- Humana (Lansing, MI)
- …and help us put health first** The Staff Utilization Management Pharmacist (VSP/PT) is a clinical expert responsible for conducting medical necessity ... required. Mandatory overtime during peak season.** **Job Description:** The Staff Utilization Management Pharmacist (VSP/PT)...**Job Description:** The Staff Utilization Management Pharmacist (VSP/PT) is a clinical professional… more
- Tenet Healthcare (Detroit, MI)
- …potentially avoidable days Other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management Balances clinical and financial requirements ... national standards for case management scope of services including: Utilization Management services supporting medical necessity and denial prevention… more
- Humana (Lansing, MI)
- …part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments… more
- Integra Partners (Troy, MI)
- …(Senior MD) serves as the clinical and strategic leader for Integra's Utilization Management (UM) and Credentialing programs. This is a full-time, 40+ hour ... quality and inter-rater reliability, overseeing audit readiness, and chairing Integra's Utilization Management Committee and Credentialing Committee. This role… more
- Behavioral Center of Michigan (Warren, MI)
- …all state mandated regulations. Maintains compliancy with regulation changes affecting utilization management . Reviews patient recrods and evaluates patient ... programs and advises physicians and other departments of regulations affecting utilization management . Consults with Social Services Department regarding the… more
- Integra Partners (Troy, MI)
- …funded programs; no current or past OIG or state sanctions + Experience performing utilization management or clinical review activities + Strong written and ... Medical Equipment (DME) and related requests to support Integra's Utilization Management (UM) operations. This full-time, salaried...clinical rationale. + Review cases escalated by UM staff and/or UM Leadership when criteria do not apply… more
- Sedgwick (Lansing, MI)
- …to verify and enter data in appropriate system(s); and to provide general support to clinical staff in a team environment. **ARE YOU AN IDEAL CANDIDATE?** We are ... Work(R) Fortune Best Workplaces in Financial Services & Insurance Utilization Review Coordinator **PRIMARY PURPOSE** : To assign ...+ Enters demographics and UR information into claims or clinical management system; maintains data integrity. +… more
- Pine Rest Christian Mental Health Services (Grand Rapids, MI)
- …direct leadership, supervision, coaching, and clinical guidance to pediatric case management staff . + Responsible for hiring, performance management , and ... this incredible work. What Will you Do? As a Clinical Services Manager for Pediatric Case Management ...stewardship. + Ensures timely and accurate completion of case management documentation, discharge planning, and utilization processes… more
- CenterWell (Lansing, MI)
- …for review of the appropriate number of Case Managers and clinical staff documentation to include starts-of-care, resumption-of-cares, and re-certifications, ... documentation in addition to feedback and recommendations by Utilization Review staff . Upon completion of the...systems and process. Competently performs patient care assignments and staff management activities. + Provides direct patient… more
- Tenet Healthcare (Commerce Township, MI)
- Clinical Social Worker Case Management Contingent Days - 2506002919 Description : DMC Huron Valley-Sinai Hospital in Oakland County is committed to outstanding ... to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient's resources and right to… more
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