Top 52 Utilization management Jobs in Lansing, Mi

Senior Utilization Management Compliance and Accreditation Specialist
Delta Dental of Michigan —Okemos, MI
- Full-time
- Hybrid work
- 7 years
- Bachelor's degree
- Business Administration
- Dental insurance
- Opportunities for advancement
PATIENT ACCESS REPRESENTATIVE
University of Michigan Health Sparrow —Lansing, MI
- Full-time
- Microsoft Outlook
- Hospital
- Medical office experience
SHS-BILLING CLERK
University of Michigan Health Sparrow —Lansing, MI
- Full-time
- Hospital
- Medical office experience
- High school diploma or GED
Clinical Case Manager Master's Level CSDD
Community Mental Health Authority —Lansing, MI
- $60,604 - $68,790 an hour
- Full-time
- Background check
- Clean driving record
- Pass drug screening
- Mileage reimbursement
- Health savings account
Quick Apply
MDS Coordinator
Regency at Lansing West —Lansing, MI
- Full-time
- Skilled nursing facility
- RN License
- Mid-level
- Health insurance
- Tuition reimbursement
Quick Apply
14d
MDS Nurse
Regency at Lansing West —Lansing, MI
- Full-time
- Nursing
- Skilled nursing facility
- RN License
- Health insurance
- Tuition reimbursement
Quick Apply
14d
Case Manager Registered Nurse (LTSS) - Field MI (Southwest Michigan)
CVS Health —Lansing, MI
- $60,522 - $129,615 a year
- Full-time
- Bilingual
- Nursing
- Microsoft Outlook
- Health insurance
- Dental insurance
5d
Case Manager Registered Nurse (LTSS) - Field MI (Wayne and Macomb County)
CVS Health —Lansing, MI
- $60,522 - $129,615 a year
- Full-time
- Bilingual
- Nursing
- Microsoft Outlook
- Health insurance
- Dental insurance
5d
UMH Sparrow Health System - BILLING SPECIALIST
University of Michigan Health Sparrow —Lansing, MI
- Full-time
- Hospital
- Medical office experience
- Mid-level
SHS-POPULATION HEALTH QUALITY SPECIALIST-MED ASST
University of Michigan Health Sparrow —Lansing, MI
- Full-time
- Hospital
- Research
- Mid-level
SUPV- LABORATORY CENTRAL PROCESSING
University of Michigan Health Sparrow —Lansing, MI
- Full-time
- Hospital
- HIPAA
- 3 years
3d
SHS-BILLING FOLLOW-UP SPECIALIST
University of Michigan Health Sparrow —East Lansing, MI
- Full-time
- Hospital
- High school diploma or GED
- Computer skills
ASC Financial Coordinator
Midwest Vision Partners —East Lansing, MI
- Full-time
- Mid-level
- High school diploma or GED
- Organizational skills
Quick Apply
UMH Sparrow Health System - Manager of Denials, Audits & Appeals
University of Michigan Health Sparrow —Lansing, MI
- Full-time
- Hospital
- HIPAA
- Finance
Clinical Case Manager (MA) - CSDD Supportive Services
Community Mental Health Authority —Lansing, MI
- $31.92 - $41.50 an hour
- Full-time
- Background check
- Clean driving record
- Pass drug screening
CASE MANAGER MSW - per diem
University of Michigan Health Sparrow —Lansing, MI
- Day shift
- Master of Social Work
- Hospital
- BLS Certification
Rehab Director
TMC —East Lansing, MI
- $35 - $38 an hour
- Full-time
- Physical & Rehabilitation Medicine
- Senior level
- Leadership
- Continuing education credits
- Paid holidays
Quick Apply
Case Manager, Registered Nurse (Oncology experience required)
CVS Health —Lansing, MI
- $54,095 - $155,538 a year
- Full-time
- Remote
- Spanish
- Nursing
- RN License
- Health insurance
- Dental insurance
SHS-RN CARE FACILITATOR - CLINICAL PROG
University of Michigan Health Sparrow —Okemos, MI
- Full-time
- Nursing
- RN License
- Hospital
MENTAL HEALTH THERAPIST - ACCESS CENTER
University of Michigan Health Sparrow —Lansing, MI
- Full-time
- Customer service
- Mid-level
- Master's degree

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utilization management jobs near lansing, mi

Senior Utilization Management Compliance and Accreditation Specialist

Delta Dental of Michigan -
Okemos, MI

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Job Details

Full-time

Benefits

Dental insurance
Opportunities for advancement

Qualifications

Bachelor's degree
Productivity software
Data collection

Full Job Description

Job Title:

Senior Utilization Management Compliance and Accreditation Specialist

Number of Positions:

Location:

Okemos, MI

Location Specifics:

Hybrid Position

Job Summary:

At Delta Dental of Michigan, Ohio, and Indiana we work to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by investing in initiatives that build healthy, smart, vibrant communities. We are one of the largest dental plan administrators in the country, and are part of the Delta Dental Plans Association, which operates two of the largest dental networks in the nation.

At Delta Dental, we celebrate our All In culture. It’s a mindset, feeling and attitude we wrap around all that we do – from taking charge of our careers, to helping colleagues and lending a hand in the community.

Position Description:

Leads the Government Programs utilization management (UM) compliance functions, including the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), Credentialing and Recredentialing (CR) accreditations, reaccreditations, and quality improvement compliance activities. Ensures adherence to URAC/NCQA standards, state UM contractual requirements, and CMS audit standards by identifying gaps, mitigating risk, and driving corrective action plans.

Primary Job Responsibilities:

Serves as subject matter expert on applicable URAC/NCQA, UM and CR compliance standards, elements, and factors.
Drafts and maintains procedures, materials and reports to maintain compliance with all applicable URAC/NCQA standards and external/ internal requirements.
Analyzes and monitors UM and CR compliance metrics; prepares routine and ad hoc reports and summarizes findings for leadership review.
Identifies potential compliance risks or barriers to maintaining URAC/NCQA accreditation and escalates concerns as appropriate; partners with internal and external stakeholders to support mitigation strategies.
Supports regulatory and accreditation-related audits by coordinating evidence collection, preparing documentation, tracking requests, and supporting corrective action plan development and follow-up for Government Programs State and MCO partners.
Partners with department leadership to support compliance and quality goals, objectives, and performance measures by providing analysis, recommendations, and implementation support.
Participates in developing and delivering internal educational programs to ensure all applicable internal stakeholders are appropriately trained on URAC/NCQA compliance requirements, best practices, time frames, and regulatory requirements.
Maintains detailed project plans to support ongoing monitoring of URAC/NCQA standards; partners with impacted departments to document status, evidence, and remediation activities.
Oversees the URAC/NCQA survey process for utilization management in collaboration with project lead, including data and information acquisition, accreditation application, scheduling, file review and other administrative tasks including scheduling and management of mock file reviews and surveys to periodically assess the company’s URAC/NCQA readiness on an annual basis.
Participates in the annual process to reflect on strengths and opportunities and applies those learnings to remain URAC/NCQA compliant and/or in support of the next accreditation cycle.
Provides compliance and accreditation subject matter support for other quality-related projects, including state utilization review/utilization management certifications or URAC-related initiatives.

Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.

#LI-Hybrid

Minimum Requirements:

Position requires a bachelor's degree in business administration, public administration, or a related field and seven years of experience in NCQA and/or URAC quality management or compliance auditing standards. Will accept any suitable combination of education, training or experience.

Position requires general knowledge of federal and state laws, rules, and regulations; strong verbal and written communication skills; effective relationship building and interpersonal skills; strong data analytical and problem-solving skills; ability to use independent judgement to make decisions; ability to multitask and work on multiple projects at any given time; and experience with Microsoft Office applications.

The company will provide equal employment and advancement opportunity within the context of its unique business environment without regard to race, color, religion, gender, gender identity, gender expression, age, national origin, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, height, weight, military status, or any other status protected under federal, state, or local law or ordinance.

Apply Now

Refine Your Search

utilization management jobs in lansing, mi

Senior Utilization Management Compliance and Accreditation Specialist

PATIENT ACCESS REPRESENTATIVE

SHS-BILLING CLERK

Clinical Case Manager Master's Level CSDD

MDS Coordinator

MDS Nurse

Case Manager Registered Nurse (LTSS) - Field MI (Southwest Michigan)

Case Manager Registered Nurse (LTSS) - Field MI (Wayne and Macomb County)

UMH Sparrow Health System - BILLING SPECIALIST

SHS-POPULATION HEALTH QUALITY SPECIALIST-MED ASST

SUPV- LABORATORY CENTRAL PROCESSING

SHS-BILLING FOLLOW-UP SPECIALIST

ASC Financial Coordinator

UMH Sparrow Health System - Manager of Denials, Audits & Appeals

Clinical Case Manager (MA) - CSDD Supportive Services

CASE MANAGER MSW - per diem

Rehab Director

Case Manager, Registered Nurse (Oncology experience required)

SHS-RN CARE FACILITATOR - CLINICAL PROG

MENTAL HEALTH THERAPIST - ACCESS CENTER

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