- CVS Health (Lansing, MI)
- …a difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review, ... initiate a Medical Director referral as needed. + Assists management with training new nurse reviewers/business partners...etc. and clinical documentation systems. + 1+ Year of Utilization Review Management and/or Medical Management… 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 (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
- Tenet Healthcare (Detroit, MI)
- …national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention. Transition ... Registered Nurse (RN) - Case Manager - 2506003285 Description...q) and other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management : Balances clinical and financial requirements… more
- University of Michigan (Ann Arbor, MI)
- …lists. **Displays Effective Skills for Patient Care Practices** : + Provides utilization management by obtaining initial and continued insurance authorizations ... REGISTERED NURSE - Partial Hospitalization Program **Early Site Maintenance** We...involved in the care of the patient. + Provides utilization management by obtaining initial and continued… more
- Veterans Affairs, Veterans Health Administration (Pontiac, MI)
- Summary The Registered Nurse - Primary Care Case Manager is responsible and accountable for all elements of the nursing process when providing and/or supervising ... for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care. Responsibilities… more
- Molina Healthcare (Grand Rapids, MI)
- …ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) ... modification of payment decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and member/provider inquiries/appeals. + Provides… more
- Veterans Affairs, Veterans Health Administration (Adrian, MI)
- …promotion, health education and coaching on wellness, disease prevention, and chronic care management . The nurse will assist in directing the provision of ... The LTC Charles S. Kettles VA Medical Center is seeking a Full-Time Registered Nurse (RN) to serve as the Patient Aligned Care Team (PACT) Outpatient Staff… more
- Veterans Affairs, Veterans Health Administration (Ann Arbor, MI)
- …Charles S. Kettles VA Medical Center is seeking a Full-Time Registered Nurse (RN) - Referral Coordination-Specialty Care, aligned under Chief of Staff. ... Responsibilities The Outpatient Staff Registered Nurse (RN) is responsible for providing competent, evidence-based outpatient care to assigned patients and oversight… more
- Henry Ford Health System (Detroit, MI)
- The Certified Registered Nurse Anesthetist (CRNA) Manager is a Certified Registered Nurse Anesthetist who ensures the delivery of safe anesthetic patient care in ... hospital/system leaders to develop a quality practice setting that supports professional nurse anesthesia practice and quality patient care. The CRNA Manager is… more
- Veterans Affairs, Veterans Health Administration (Ann Arbor, MI)
- Summary The LTC Charles S. Kettles VA Medical Center is seeking a Full-Time Registered Nurse (RN) to serve as the Progressive Care Unit Registered Nurse (RN) for ... aligned under the Primary Care Service. Responsibilities Progressive Care Registered Nurse (RN) is responsible for providing competent, evidence-based care to… more
- Veterans Affairs, Veterans Health Administration (Ann Arbor, MI)
- …LTC Charles S. Kettles VA Medical Center is seeking a Full-Time Registered Nurse (RN) - Inpatient Community Living Center (CLC), aligned under Patient Care Services. ... Responsibilities Inpatient Staff Registered Nurse (RN) is responsible for providing competent, evidence-based care to assigned patients with oversight of licensed… more
- Veterans Affairs, Veterans Health Administration (Iron Mountain, MI)
- …information, refer to Required Documents below. Responsibilities The Float Registered Nurse (RN) is responsible for providing competent, evidence-based care to ... of licensed vocational nurses/nursing assistants, as appropriate to the setting. The nurse will assist in directing the provision of nursing education, orientation,… more
- Henry Ford Health System (Detroit, MI)
- …Proficiency with computers, electronic health records (EHR), database systems, and utilization review/case management documentation systems. + Knowledge of CMS, ... resources to optimize patient outcomes and promote efficient resource utilization . Key Responsibilities: Clinical Care Coordination: + Conduct comprehensive patient… more
- Molina Healthcare (MI)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... **JOB DESCRIPTION** **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for… more
- Tenet Healthcare (Detroit, MI)
- Registered Nurse (RN) - Nursing Admin - 2506002696 Description : DMC Detroit Receiving Hospital , Michigan's first Level I Trauma Center, helped pioneer the ... and accredited DMC Rosa Parks Geriatric Center of Excellence. SUMMARY The Registered Nurse (RN) is a member of the Patient Care Services Team. The Registered… more