- R1 RCM (Detroit, MI)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Nurse ** , you will help our ... in this remote position. **Here's what you will experience working as a Utilization Review Nurse :** + Perform initial admission and continued stay reviews… more
- Trinity Health (Ann Arbor, MI)
- …time **Shift:** Day Shift **Description:** **POSITION PURPOSE** + The Utilization Review Specialist is a Registered Nurse that is responsible for ... clinical, age specific, developmental, cultural and spiritual needs. Facilitates utilization management documentation and appropriate communication with external agencies.… more
- Lincoln Financial (Lansing, MI)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… more
- McLaren Health Care (Pontiac, MI)
- **Position Summary:** Responsible for Utilization and Care Management services to the Emergency Center. Advises providers to determine initial medical necessity and ... on all patients reviewed in the ED. Conducts initial review using InterQual, MCG and other tools, assists provider...assigned. #LI-KH1 _Required_ + State licensure as a Registered Nurse (RN) + Bachelor's degree in nursing from accredited… more
- Zurich NA (Lansing, MI)
- AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is seeking an AVP, Utilization Review & Pharmacy. This is a fully remote position, offering ... flexibility of a home-based office. As the AVP of Utilization Review & Pharmacy, you will lead...of experience in the Nursing areaAND + Registered Professional Nurse license in residential area and in operational national/local… more
- Tenet Healthcare (Detroit, MI)
- Group Director Utilization Review - 2506000536 Description : The Detroit Medical Center (DMC) is a nationally recognized health care system that serves patients ... diverse employers in Southeast Michigan. Summary Description SUMMARY: The Group Director, Utilization Review will perform the functions necessary to support and… more
- Henry Ford Health System (Troy, MI)
- …Under minimal supervision, reviews and screens the appropriateness of services, the utilization of hospital resources and the quality of patient care rendered. ... and critical thinking to maximize reimbursement. EDUCATION/EXPERIENCE REQUIRED: + Registered Nurse required. + Minimum 3-5 years of clinical experience required. +… more
- Tenet Healthcare (Detroit, MI)
- Registered Nurse Case Manager Contingent Days - 2506001465 Description : DMC Harper University Hospital has distinguished itself in surgery and medicine and is known ... to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patients resources and right to… more
- Evolent (Lansing, MI)
- …adjudication of processed appeals. **What You Bring:** + 1-3 years' experience in clinical Appeals Review or Utilization Management Review as an LPN or LVN ... the mission. Stay for the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact as part of… more
- McLaren Health Care (Lansing, MI)
- …to D/C). 4. Identifies unsigned level of care (LOC) orders; communicates with utilization management nurse and obtains orders from providers. 5. Reviews current ... top decile performance in length of stay, cost efficient resource utilization , preventing readmissions and unnecessary emergency room visits. Works collaboratively… more