Utilization Review Nurse Jobs in Michigan

538 jobs

A-Line Staffing Solutions is looking for RN / Registered Nurse / HEDIS / Chart Auditing / Utilization Review Must be willing to travel throughout Michigan Some overnight stays may be required Must have reliable transportation Will be tested for computer abilities Must have experience as RN / Registered Nurse / HEDIS / Chart Auditing / Utilization Review Benefits: A-Line Staffing now offers ...

Bachelor's Degree; Michigan RN license; Certified Professional in Utilization Review / Management preferred. 3 years recent acute care utilization management experience, Knowledge of regulations relative to utilization review. Knowledge of Federal, State and local regulations. Understanding of computers and software in order to collect and report information for required data sources. Ability to w...

Bachelor's Degree; Michigan RN license; Certified Professional in Utilization Review / Management preferred. 3 years recent acute care utilization management experience, Knowledge of regulations relative to utilization review. Knowledge of Federal, State and local regulations. Understanding of computers and software in order to collect and report information for required data sources. Ability to w...

Bachelor's Degree; Michigan RN license; Certified Professional in Utilization Review / Management preferred. 3 years recent acute care utilization management experience, Knowledge of regulations relative to utilization review. Knowledge of Federal, State and local regulations. Understanding of computers and software in order to collect and report information for required data sources. Ability to w...

Bachelor's Degree; Michigan RN license; Certified Professional in Utilization Review / Management preferred. 3 years recent acute care utilization management experience, Knowledge of regulations relative to utilization review. Knowledge of Federal, State and local regulations. Understanding of computers and software in order to collect and report information for required data sources. Ability to w...

Title: Analyst-Utilization Review City, State: Detroit, MI Location: St. John Hospital & Medical Center Department: Rehab Support Services 001 Additional Job Details: FT Rotating Marketing Statement St. John Providence Health System is a member of Ascension Health, the largest not-for-profit Catholic Health system in the United States. Our Mission, Vision and Values: St. John Providence Hea...

Title: Analyst-Utilization Review City, State: Detroit, MI Location: St. John Hospital & Medical Center Department: Rehab Support Services 001 Additional Job Details: FT Rotating Marketing Statement St. John Providence Health System is a member of Ascension Health, the largest not-for-profit Catholic Health system in the United States. Our Mission, Vision and Values: St. John Providence Hea...

ADN or BSN POSITION PURPOSE Responsible for facilitating collection of patient clinical information and application of clinical criteria considering clinical, age specific, developmental, cultural and spiritual needs. Facilitates utilization management documentation and appropriate communication with external agencies. Demonstrates area designated competencies. ESSENTIAL FUNCTIONS AND RESPONSIBI...

Overview Henry Ford Health System, one of the largest and most comprehensive integrated U.S. health care systems, is a national leader in clinical care, research and education. The system includes the 1,100-member Henry Ford Medical Group, six hospitals, Health Alliance Plan (a health insurance and wellness company), Henry Ford Physician Network, a 150-site ambulatory network and many other healt...

Overview Henry Ford Health System, one of the largest and most comprehensive integrated U.S. health care systems, is a national leader in clinical care, research and education. The system includes the 1,100-member Henry Ford Medical Group, six hospitals, Health Alliance Plan (a health insurance and wellness company), Henry Ford Physician Network, a 150-site ambulatory network and many other healt...

A-Line Staffing is currently recruiting for 6 Registered Nurses with Utilization Review experience to work for a large healthcare insurance provider in the Metro Detroit Area. Great way to get your foot in the door for a large company in a widely growing industry! This position involves doing chart review, chart auditing, and utilization review. Some telephone triage experience preferred. Will pr...

Job Description Under general supervision, coordinates an effective Medical Staff peer review process that supports medical staff reappointment, advancement, and clinical quality in compliance with the Joint Commission including ongoing physician performance evaluation (OPPE) and focused professional practice evaluation (FPPE) standards for the Detroit Medical Center. Identifies clinical and perfo...

The Judge Group is currently seeking a CARE REVIEW CLINICIAN II. This job will have the following responsibilities: Shift: 8:30 am - 5 pm Providing utilization review for the Medicaid line of business. Primarily in patient, skilled nurses facilities, rehab, and home healthcare. Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review ...

Job Summary Oversees the integrated Care Access and Monitoring team responsible for prior authorizations, inpatient and outpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Monitors information daily as appropriate including member metrics and staff product...

Overview Our health system thrives on teamwork, and we know our employees achieve the greatest results when they are working together for a common goal - to provide care for our patients. If you enjoy working in a collaborative environment then we have a job for you! Henry Ford Health System is one of the country's largest health care systems and a national leader in clinical care, research and ...

Job Summary Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorization...

Overview Henry Ford Health System, one of the largest and most comprehensive integrated U.S. health care systems, is a national leader in clinical care, research and education. The system includes the 1,100-member Henry Ford Medical Group, six hospitals, Health Alliance Plan (a health insurance and wellness company), Henry Ford Physician Network, a 150-site ambulatory network and many other healt...

Job Summary Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorization...

Job Summary Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorization...

POSITION SUMMARY At aetna we are committed to ensure that our members receive the best, most appropriate care. As a Utilization Management (UM) Nurse Clinician, you will work in a fast paced, autonomous, team oriented environment where turn around times and meeting deadlines are critical. Fundamental Components: Utilizes clinical skills to coordinate, document and communicate all aspects of the...