- Ascension Health (Kalamazoo, MI)
- …management experience preferred. **Additional Preferences** There will be a dual focus on case management and utilization review in this position + Case ... prior to hire date or job transfer date. + Registered Nurse credentialed from the Michigan Board...Management experience - Strongly preferred + Utilization Review experience - Strongly preferred **Why… more
- Humana (Lansing, MI)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- McLaren Health Care (Detroit, MI)
- …degree in coding/medical records/billing or healthcare related field + Two years of case management or utilization review , billing, or coding experience + ... **Position Summary:** Responsible for providing assistance to the Utilization Manager (UM) RN in the...based on medical necessity. 2. Performs concurrent and retrospective utilization management -related activities and functions to ensure… more
- Munson Healthcare (Traverse City, MI)
- …the State of Michigan. + Minimum of three years clinical experience required. Previous utilization review and/or case management in a hospital or insurance ... assessment and critical thinking skills necessary to provide utilization review responsibilities. Superior organization and time management skills required;… more
- G-TECH Services, Inc. (Detroit, MI)
- …clinical experience which may include acute patient care, discharge planning, case management , and utilization review , etc. Demonstrated clinical knowledge ... requirements: Associate Degree or nursing diploma required, Triage, case management or utilization review experience,...a RN with a current and unrestricted Registered Nurse license **Category** _Benefits_ **Function** _HR… more
- Henry Ford Health System (Detroit, MI)
- …community partners to support patient needs beyond the hospital setting. Qualifications: + Registered Nurse ( RN ) with active licensure + Minimum [number] ... with computers, electronic health records (EHR), database systems, and utilization review /case management documentation systems....work in a fast-paced environment. Licenses and Certifications: + Registered Nurse ( RN ) with a… more
- LifePoint Health (Hancock, MI)
- …growth of our employees both professionally and personally. We are seeking a detail-oriented Utilization Review Registered Nurse to be responsible for ... RN will be part of an excellent team of Case Management RN 's. As a Utilization Review RN you will work in multiple electronic medical… more
- G-TECH Services, Inc. (Detroit, MI)
- …of clinical experience which may include acute patient care, discharge planning, case management , and utilization review with another insurance provider, ... such as NICU/OB/BH/Substance Abuse * * InterQual/MCG or other utilization review experience preferred Required Skills/Experience -...care setting Education/Certifications - Include: * Must be a RN with an unrestricted Registered Nurse… more
- Corewell Health (Royal Oak, MI)
- …, utilization review , home care and/or discharge planning. Preferred + Registered Nurse ( RN ) - State of Michigan License Upon Hire required ... all hospitalized patients. 1. Identifies patients that need care management services (ie utilization review ;...accredited school of nursing. + Preferred Will consider non-BSN RN if actively pursuing a bachelor's degree in nursing… more
- Corewell Health (Farmington Hills, MI)
- …management , utilization review , home care and/or discharge planning. Preferred + Registered Nurse ( RN ) - State of Michigan Upon Hire required How ... all hospitalized patients. + Identifies patients that need care management services (ie utilization review ;...accredited school of nursing. + Preferred Will consider non-BSN RN if actively pursuing a bachelor's degree in nursing… more
- Trinity Health (Ann Arbor, MI)
- …weeks from 8 am to 5 pm Monday through Friday. **WHAT YOU WILL DO** + The RN Registered Nurse Case manager is responsible for conducting a focused assessment ... leadership role in achieving desired clinical, financial and resource utilization outcomes. + This is achieved by coordinating care...and clinical risk issues and documentation completeness. + The RN Registered Nurse Case Manager… more
- Trinity Health (Howell, MI)
- …weeks from 8 am to 5 pm Monday through Friday. **WHAT YOU WILL DO** + The RN Registered Nurse Case manager is responsible for conducting a focused assessment ... leadership role in achieving desired clinical, financial and resource utilization outcomes. + This is achieved by coordinating care...and clinical risk issues and documentation completeness. + The RN Registered Nurse Case Manager… more
- Molina Healthcare (Warren, MI)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **WORK SCHEDULE: Mon - Fri / Sun… more
- Fresenius Medical Center (Detroit, MI)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Tenet Healthcare (Detroit, MI)
- Registered Nurse Case Manager Adult Services Full Time Days - 2406004417 Description : **$25,000 Sign on Bonus, with required relevant experience** DMC Harper ... for case management scope of services including: Utilization Management supporting medical necessity and denial... experience preferred. 3. License to practice as a Registered Nurse in the State of Michigan.… more
- Corewell Health (Dearborn, MI)
- …, utilization review , home care and/or discharge planning. Preferred + Registered Nurse ( RN ) - STATE_MI State of Michigan Upon Hire required ... of care and cost effectiveness through the integration and functions of utilization management , and/or care coordination, discharge planning, and appropriate… more
- Munson Healthcare (Manistee, MI)
- …experience will be considered in lieu of a Bachelor's degree in nursing (must have RN license). If Registered Nurse , must be licensed to practice in ... customer service/interpersonal skills at all times. 6. Maintains working knowledge/experience in utilization management , managed care, and payer issues that may… more
- ChenMed (Eastpointe, MI)
- …of care and cost effectiveness through the integrating and functions of case management , utilization review and discharge planning. The incumbent in ... achieving desired clinical outcomes within specific timeframe. + Conducts review for appropriate utilization of services from...a related clinical field preferred. + A valid, active Registered Nurse ( RN ) license in… more
- Highmark Health (Lansing, MI)
- …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- Sharecare (Lansing, MI)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... and their Primary Care Provider according to the disease management program intervention guidelines. An RN is...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more