Utilization Review Nurse Jobs in Michigan

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503 Michigan Utilization Review Nurse jobs found on Monster.

Jobs 1 to 20 of 503
Job Description Registered Nurse (RN) Review Analyst Responsible for the approval or rejection of claims Admissions approvals Telephone triage Benefit interpretation May be required to enter or reference data via PC and/or CRT terminal. Other related skills may be required to perform this job. Expertise in the use of medical terminology Utilization Review Chart Auditing Details 40 hour...
Job Summary: Clinical Utilization Review / Appeals / Registered Nurse: • Manage all aspects of the certification for payment process. • Complete admission authorization, out of network transfers, initiates concurrent authorization, completes retrospective authorizations and minimizes financial risk by maintaining timely communication with all payers. • Initiate and complete the appeals process ...
Utilization Review RN Providing both satisfying and challenging work along with a highly professional and friendly work atmosphere, Sedgwick Claims Management Services, Inc. has a strong commitment to its colleagues and its clients. If you are seeking a place where you can do great things for those whose lives you touch while maximizing your own career possibilities, Sedgwick CMS is the place for...
JOB DESCRIPTION Manager / Denials - Utilization Review / Registered Nurse MANAGER LEVEL POSITION- Valid RN License BSN preferred; Certification as a CPHQ, CCM, ACM or IQCI preferred 5 years experience in Ultization Management, denials management or related field Knowledge of hospital billing systems preferred. Knowledge of statistics, data collection, analysis and data presentation. Knowled...
*CURRENTLY INTERVIEWING* Job Summary of the Registered Nurse (RN) / Inpatient Case Manager / Utilization Review: • Collaborate with patient/family/health team to identify the appropriate resources needed for the next level of care • Resolve patient care issues that may impact length of stay, cost and/or quality of care. • Monitor daily operations that may impact patient care/pace of care and t...
Under the direction of the Corporate Risk Management Specialist, the UM/UR specialist is responsible for implementing the Authority’s Utilization Management and Review Program. This position monitors a broad spectrum of system activity to ensure that consumers are provided services in the most efficient and cost effective manner consistent with quality standards, person centered planning, and med...
Are you ready for an exciting opportunity to enhance your career skill set? Do you want to be a part of one of the country’s fastest growing provider of care facilities? If so, check out this opportunity as a Utilization Review Nurse (RN). This position requires an individual who can work under minimal supervision to review and manage the utilization of hospital resources to ensure the proper leve...
Detroit Medical Center Detroit, MI, 48222
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, direct admits, proc...
Detroit Medical Center Detroit, MI, 48222
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, direct admits, proc...
This role with Aetna is a telework/work-at-home opportunity in which you will also train from home in a virtual setting. In order to be considered for this position, you must be fully comfortable working Monday-Friday, 8:00am - 5:00pm Pacific Standard Time (PST). Current Aetna employees are encouraged to apply! POSITION SUMMARY As a Registered Nurse (RN) - Remote Utilization Management Nurse Co...
This role with Aetna is a telework/work-at-home opportunity in which you will also train from home in a virtual setting. In order to be considered for this position, you must be fully comfortable working Monday-Friday, 8:00am - 5:00pm Pacific Standard Time (PST). Current Aetna employees are encouraged to apply! POSITION SUMMARY As a Registered Nurse (RN) - Remote Utilization Management Nurse Co...
Aetna Inc. Detroit, MI
Job Description Aetna Better Health Premier Plan, a MI Health Link Plan, is looking for caring people who share our vision of helping to provide innovative, community-based health care for dual-eligible Medicare-Medicaid members in Michigan. Aetna Better Health of Michigan is a great place to work. As an employee, not only will you be helping others, you'll be part of a team just as dedicated as ...
Munson Medical Center Traverse City, MI, 49685
ENTRY REQUIREMENTS Current Registered Nurse licensure within State of Michigan. BSN preferred. Minimum of three years clinical experience in acute care setting. Previous utilization review and/or case management experience preferred. Demonstrates effective verbal and written communication skills with internal and external customers, i.e., insurance companies, case managers, home care agencies, phy...
Henry Ford Health Wyandotte, MI
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 ...
Henry Ford Health Wyandotte, MI
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 ...
Henry Ford Health Southfield, MI
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 Purpose: Promotes and restores patients' health by completing the nursing process; collaborating with physicians and multidisciplinary team members; providing physical and psychological support to patients, friends, and families; supervising assigned team members. Duties: * Identifies patient care requirements by establishing personal rapport with potential and actual patients and other per...
Molina Healthcare Inc Troy, MI
Job Summary Works with the Utilization Management team and is primarily responsible for prior authorizations. According to guidelines provides 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. Assesses services for Molina Members to ensure ...
Molina Healthcare Troy, MI
Job Summary Works with the Utilization Management team and is primarily responsible for prior authorizations. According to guidelines provides 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. Assesses services for Molina Members to ensure o...
Molina Healthcare Troy, MI
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 authorizations...

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Healthcare Career Tools

Nurse Manager

Salaries

$53,040.00 - $103,400.00
Typical Salary for Nurse Manager in Michigan
(313 Respondents)
Source: Monster.com Careerbenchmarking Tool

Education / Training

Bachelor's
41.2%
Master's
30.6%
Associates
22.7%
(216 Respondents)
Source: Monster.com Careerbenchmarking Tool

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