Utilization Review Nurse Jobs in Michigan

542 jobs

Job Description: Prominent managed care organization is seeking a Care Review Clinician II to work in Troy, MI. This is a four (4) to six (6) month contract position with the possibility of extension and/or temp to hire. Max pay is $44.00/hour. Hours are Monday-Friday 8:30am-5pm. Summary: This position is responsible for providing utilization review for the Medicaid and Medicare lines of bus...

Our client is currently seeking a Utilization Review Registered Nurse. Responsibilities: Responsible for inpatient medical necessity/utilization review and other utilization management activities that provide patients with the correct care Provide daily review and evaluation of members that require hospitalization and/or procedures providing previous authorizations and/or concurrent review Ens...

Job Description Under limited direction and according to established policies and procedures, responsible for collaborating with physicians and applying medical necessity criteria (severity of illness and intensity of service) to determine appropriate level of care (inpatient, outpatient, observation, or community) at all points of entry. Access location points to include emergency department, dir...

Subsidiary: McLaren Flint - JOB SUMMARY The Utilization Reviewer partners with the health care team to ensure appropriate insurance reimbursement of hospital admissions based on medical necessity. REQUIRED QUALIFICATIONS Current Michigan licensure as Registered Nurse Flexibility of hours/days to meet needs of patients, families, and organization Two years of acute, medical surgical experienc...

Requisition Number 15-3781 Post Date 7/28/2015 Title Utilization Review Nurse Job Family Nursing Subsidiary McLaren Flint Department 91590 - Utilization Management Location Flint Region City Flint State MI Full Time No Hours per 2 week pay period 0 Schedule Variable Weekends and/or Holidays Required No On Call Required No Description JOB SUMMARY The Utilization Reviewer partners wi...

Job Title Utilization Review Specialist/RIM/3 yrs RN exp required Job Location Name Rehabilitation Institute of MI Job Description Under limited direction and according to established policies and procedures, responsible for collaborating with physicians and applying medical necessity criteria (severity of illness and intensity of service) to determine appropriate level of care (inpatient, outpa...

Under limited direction and according to established policies and procedures, responsible for collaborating with physicians and applying medical necessity criteria (severity of illness and intensity of service) to determine appropriate level of care (inpatient, outpatient, observation, post acute, or community) at all points of entry. Access location points may include emergency department, direct...

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...

Our Case Managers, play an essential role in the patient experience by serving as the liaison between the patient and the facility/physician. In this role, you will facilitate the patient's hospitalization from pre-admission through post-discharge. You will coordinate with physicians, nurses, social workers and other health team members to expedite medically appropriate, cost-effective care; asses...

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...

Utilization Review Specialist Department: Social Services Schedule: Full-Time Shift: Day shift Hours: 16-40 hrs Salary: $23.35-$34.97 Job Details: ENTRY REQUIREMENTS Current Registered Nurse licensure within State of Michigan. BSN preferred. Minimum of three years clinical experience required. One to three years utilization review in a hospital or insurance industry preferred. Previous u...

Job Title Utilization Review Specialist/Full-time Days Job Location Name Detroit Receiving Hospital/UHC Job Description Summary Description Under limited direction and according to established policies and procedures, responsible for collaborating with physicians and applying medical necessity criteria (severity of illness and intensity of service) to determine appropriate level of care (inpati...

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 1,200-member Henry Ford Medical Group, five hospitals, Health Alliance Plan (a health insurance and wellness company), Henry Ford Physician Network, a 150-site ambulatory network and many other heal...

Summary Description Under limited direction and according to established policies and procedures, responsible for collaborating with physicians and applying medical necessity criteria (severity of illness and intensity of service) to determine appropriate level of care (inpatient, outpatient, observation, post acute, or community) at all points of entry. Access location points may include emergen...

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...

Subsidiary: McLaren Health Plan - McLaren Health Plan, recognized by Modern Health Care as one of the 100 Best Places to Work for four years in a row, is seeking a Ultization Intake Specialist to join our Medical Managment Team. POSITION SUMMARY Responsible for the intake of information regarding the authorization of services for members of all product lines, including communication to the case...

Job Title Utilization Review Specialist RN-CRM Dept. (part time/every week-end) Job Location Name Harper Hospital Job Description Under limited direction and according to established policies and procedures, responsible for collaborating with physicians and applying medical necessity criteria (severity of illness and intensity of service) to determine appropriate level of care (inpatient, outpat...