- CVS Health (Lansing, MI)
- …And we do it all with heart, each and every day. **Position Summary** The ** Utilization Management Clinical Nurse Consultant** utilizes clinical ... Arizona Time Zone. **Preferred Qualifications** : + Previous experience with utilization management . + Previous clinical experience in Emergency Department,… more
- McLaren Health Care (Bay City, MI)
- …with an acute care hospital** _Preferred:_ + Experience in utilization management /case management , critical care, clinical documentation, or patient ... **Department:** Utilization Management **Shift:** Days **Daily Work...vs. outpatient) based on medical necessity. Actively seeks additional clinical documentation from the physician to optimize hospital reimbursement… more
- McLaren Health Care (Port Huron, MI)
- …with an acute care hospital **Preferred:** ⦁ Experience in utilization management /case management , critical care, clinical documentation, or patient ... as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate… more
- 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 ... internal partners (eg, Provider Relations, Quality) to resolve escalations and address utilization management issues. + Represent UM nursing team in internal… more
- CVS Health (Lansing, MI)
- …**Position Summary** Join our Utilization Management team as a Nurse Consultant, where you'll apply clinical judgment and evidence-based criteria to ... listening, and use of a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed,… more
- Integra Partners (Troy, MI)
- …experienced in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual will play a key ... UM program. Salary: $60,000.00/annual JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES The UM Nurse 's responsibilities include but are not limited to: + Perform… more
- CenterWell (Lansing, MI)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Corewell Health (Grand Rapids, MI)
- …2017 (Spectrum Health Ludington Hospital) Required. + 2 years of relevant experience clinical nursing and or case management /managed care or related field ... Required + 5 years of relevant experience clinical nursing and or case management /managed care...management /managed care or related field Preferred + Registered Nurse (RN) - State of Michigan Upon Hire required… more
- Tenet Healthcare (Detroit, MI)
- …potentially avoidable days Other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management Balances clinical and financial requirements ... healthcare team where compassion meets innovation! As a Registered Nurse with us, you'll have the opportunity to make...for case management scope of services including: Utilization Management services supporting medical necessity and… more
- Corewell Health (Caledonia, MI)
- …and continued stay. Educates medical staff/other health care professionals regarding utilization management and quality requirements. Makes recommendations and ... provides financial and utilization management (UM) information to other members...clinical settings, or related experience Required + Registered Nurse (RN) - State of Michigan required How Corewell… more