- 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)
- …we do it all with heart, each and every day. **Position Summary** The ** Utilization Management Clinical Nurse Consultant** utilizes clinical skills to ... Arizona Time Zone. **Preferred Qualifications** : + Previous experience with utilization management . + Previous clinical experience in Emergency Department,… more
- CVS Health (Lansing, MI)
- … solutions that promote high-quality healthcare for members. **Position Summary** Join our Utilization Management team as a Nurse Consultant, where you'll ... 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 ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Corewell Health (Grand Rapids, MI)
- …nursing and or case management /managed care or related field Preferred + Registered Nurse (RN) - State of Michigan Upon Hire required + Basic Life Support (BLS) ... of insurance prior authorizations, initial reviews, continuous stay reviews and appeals. Nurse Care Manager - Plans and prioritizes care for individuals and… more
- McLaren Health Care (Bay City, MI)
- **Department:** Utilization Management **Shift:** Days **Daily Work Times:** 8am - 4:30pm **Scheduled Hours per Pay:** 40 Position Summary: Responsible for ... as Assigned: 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate… more
- McLaren Health Care (Port Huron, MI)
- …as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate ... or order entry for timeliness, appropriateness and completeness as pertains to the utilization management process including level of care, medical necessity, and… more
- Tenet Healthcare (Detroit, MI)
- …national standards for case management scope of services including: Utilization Management services supporting medical necessity and denial prevention ... potentially avoidable days Other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management Balances clinical and financial requirements 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...multiple clinical settings, or related experience Required + Registered Nurse (RN) - State of Michigan required How Corewell… more