Utilization Review Nurse Jobs in Michigan

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595 Michigan Utilization Review Nurse jobs found on Monster.

Jobs 1 to 20 of 595
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...
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...
Registered Nurse needed for a hospital system to function as a Utilization Review/Case Management RN. This is a 3-6 month contract assignment with the possibility for extension. Will be working in the Utilization Review and Denial/Appeals Dept. Must have at least 3-5 years of acute patient care experience and at least 1-3 years of utilization review experience. Qualified candidate need to have an ...
American Medical Personnel Services Grand Rapids, MI
Apply here or email a resume to ***** Summary: The Utilization Review Nurse ensures services meet memberâ??s health needs and promotes the provision of high quality care in the most appropriate and cost-effective setting by: Conducting admission and concurrent reviews of patients admitted for inpatient, sub acute, SNF, hospice facility care within and outside the provider netw...
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...
Title: Analyst-Utilization Review City, State: Detroit, MI Location: St. John Hospital & Medical Center Department: Case Management 002 Additional Job Details: FT Days 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 Health System,...
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...
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...
Subsidiary: McLaren Bay Region - JOB SUMMARY Certifies admissions and continued stays according to third party guidelines; refers cases to the physician advisors as needed. Coordinates audits and manages the denial/appeals process with third party payers. Monitors the appropriate utilization of hospital resources REQUIRED QUALIFICATIONS Associates Degree Valid Michigan Registered Nurse licens...
Marten Transport Detroit, MI
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...
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...
POSITION SUMMARY: The incumbent reviews medical bills utilizing professional knowledge and clinical experience to determine relationship of services billed to the covered injury; applies appropriate review guidelines, assesses appropriate use of medical coding; identifies over-utilization of treatment and makes appropriate reimbursement recommendations. The incumbent assists with Utilization Revi...
Job Summary of the Registered Nurse (RN) / Case Manager / Utilization Management Department: Clinical Quality Management Oversees and coordinates the discharge planning and utilization management activities for assigned caseload. Facilitate appropriate utilization of resources and efficient patient progression through the continuum of health care resulting in the highest quality and most cost-ef...
Utilization Management, Team Lead I have a permanent jobfor Utilization Management, Team Lead in - Michigan - Grand Rapids. If interested pl send me your resume with location, Immigration status, Expected Salary. Thanks Debdas Patnaik 248 795 0378 ***** Benefits - Full Relocation Assistance Available - Yes Commission Compensation – No Bonus Eligible - No Overtime Eligible – ...
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 ...
Summary: The Utilization Review Nurse ensures services meet member’s health needs and promotes the provision of high quality care in the most appropriate and cost-effective setting by: Conducting admission and concurrent reviews of patients admitted for inpatient, sub acute, SNF, hospice facility care within and outside the provider network. Reviewing authorization requests for facility based car...
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 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 ...

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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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