Top 5 Utilization review nurse Jobs in Big Rapids, Mi

RN Utilization Management
OpTech LLC —Michigan
- $37 - $39 an hour
- Full-time
- Remote
- Background check
- Nursing
- Addiction Medicine
- Health insurance
- Dental insurance
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3d

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RN Utilization Management
OpTech LLC —Michigan
*Registered Nurse* unrestricted/current Michigan RN license. *Bachelor’s degree* in nursing, allied health, business, or related field _preferred_.
$37 - $39 an hour
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3d
Utilization Management Coordinator- Full Time
SHERIDAN COMMUNITY HOSPITAL —Sheridan, MI
Required: Current RN license in the state of Michigan. The ideal candidate will ensure that care is delivered in accordance with hospital policies, payer…
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6d

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Case Manager (RN) - Full-Time
OhioHealth Rehabilitation Hospital —Columbus, OH
Current Licensure per state guidelines in clinical or related discipline OR a Bachelor's or Master's in a health or human services discipline.
$70,000 - $84,000 a year
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5d
Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…

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RN Utilization Management

OpTech LLC -
Michigan

Quick Apply

Job Details

Full-time
$37 - $39 an hour
3 days ago

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance

Qualifications

Nursing
RN License
Microsoft Office
Acute care facility experience
Bachelor's degree
Utilization management
Resource utilization in healthcare
Typing

Full Job Description

We are seeing a Michigan RN Utilization Manager. This is a 100% remote position in Michigan.

Job Description:
Perform prospective, concurrent and retrospective review of inpatient, outpatient, ambulatory and ancillary services to ensure medical necessity, appropriate length of stay, intensity of service and level of care, including appeal requests initiated by providers, facilities and members. May establish care plans and coordinate care through the health care continuum including member outreach assessments.

EDUCATION AND EXPERIENCE:

Registered Nurse unrestricted/current Michigan RN license
2 + yr clinical experience – acute care
Utilization Management experience/role
Technical – MS Office, Type 35+ WPM, Dual monitors, multiple systems
1 yr health insurance plan experience or managed care environment preferred.
Bachelor’s degree in nursing, allied health, business, or related field preferred.
Certification in Case Management preferred

ESSENTIAL DUTIES AND RESPONSIBILITIES:
1. Review, research and authorize requests for authorization of elective, direct, ancillary, urgent, emergency, etc. services. Contact appropriate medical and support personnel to identify and recommend alternative treatment, service levels, length of stays, etc. using approved clinical protocols.
2. Analyze, research, respond to and prepare documentation related to retrospective review requests and appeals in accordance with local, state and federal regulatory and designated accreditation (e.g. NCQA) standards.
3. Establish, coordinate and communicate discharge planning needs with appropriate internal and external entities.
4. Analyze patterns of care associated with disease progression; identify contractual services and organize delivery through appropriate channels.
5. Research and resolve issues related to benefits, member eligibility, non-elective and non-authorized services, coordination of benefits, Mental Health, Substance Abuse care coordination, etc.
6. Identify and document quality of care issues; resolve or route to appropriate area for resolution.
7. Follow out-of-area/out-of-network services and make recommendations on patient transfer to in-network services and/or alternative plans of care.
8. Develop and deliver targeted education for provider community related to policies, procedures, benefits, etc.
9. As needed and in conjunction with Provider Services, may identify and negotiate reimbursement rates for non-contracted providers for services.
10. Other duties may be assigned based on designated department assignment.

Pay: $37.00 - $39.00 per hour

Benefits:

Dental insurance
Health insurance
Paid time off
Vision insurance

Experience:

Clinical Nursing-Acute Care: 2 years (Required)
Utilization Management: 2 years (Required)
Health Insurance: 1 year (Preferred)

Work Location: Remote

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utilization review nurse jobs in big rapids, mi

RN Utilization Management

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