Top 97 Utilization management Jobs in Grand Rapids, Mi

Case Manager (RN) - Case Management * Evenings - 36hrs/wk.
University of Michigan Health-West —Wyoming, MI
- Full-time
- Nursing
- RN License
- Bachelor of Science
Vice President, Care Management, Utilization Management & Operations - Priority Health
Corewell Health —Grand Rapids, MI
- Full-time
- Hybrid work
- RN License
- Office
- Master's degree
- Health insurance
Licensed Therapist - VA First Responder Program
Sanford Careers —Grand Rapids, MI
- $60,000 - $70,000 a year
- Part-time
- Writing skills
- HIPAA
- Mid-level
Quick Apply
RN Med Surg
Corewell Health —Grand Rapids, MI
- Full-time
- Acute care
- Nursing
- Surgery
RN Med Surg
Corewell Health —Grand Rapids, MI
- Full-time
- Acute care
- Surgery
- Inpatient
Lead Dental Assistant
Emergency Dental of America —Grand Rapids, MI
- $27 - $29 an hour
- Weekends as needed
- Background check
- Dental office
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
4d
RN Med Surg
Corewell Health —Grand Rapids, MI
- Full-time
- Acute care
- Nursing
- RN License
RN - Behavioral Health - Mental Health (Varied)
Medlinkhealth —Grand Rapids, MI
- $28.90 - $41.00 an hour
- 12 hour shift
- Nursing
- RN License
- Hospital
- Free parking
- Health savings account
Quick Apply
Registered Nurse - Transfer Coordinator
Trinity Health Michigan —Grand Rapids, MI
- 12 hour shift
- Nursing
- RN License
- Hospital
Quick Apply
Social Work Navigator
Tandem365 —Grand Rapids, MI
- $55,000 - $78,000 a year
- Full-time
- Hybrid work
- Mid-level
- 3 years
- Communication skills
- Mileage reimbursement
Quick Apply
RN Care Manager - Care Management at Home Program
Trinity Health Michigan —Grand Rapids, MI
- Full-time
- Nursing
- RN License
- Bachelor of Science
Health Information Management Supervisor
Cherry Health (Cherry Street Services) DBA —Grand Rapids, MI
- Full-time
- Anatomy knowledge
- Microsoft Excel
- Microsoft Outlook
- 403(b) matching
- Paid holidays
Quick Apply
Registered Nurse - Transfer Center Coordinator
Trinity Health Michigan —Grand Rapids, MI
- 12 hour shift
- Nursing
- RN License
- Hospital
Emergency Care Technician - Emergency Department * Nights (7p-7a) - 36hrs/wk
University of Michigan Health-West —Wyoming, MI
- Full-time
- CPR Certification
- Nursing
- Customer service
Senior Operations Specialist Clinical Standardization
Corewell Health —Grand Rapids, MI
- Full-time
- Hybrid work
- 5 years
- Office
- Master's degree
4d
Emergency Care Technician - Emergency Department * Evenings (7p-7a) - 24hrs/wk
University of Michigan Health-West —Wyoming, MI
- Full-time
- CPR Certification
- Nursing
- Customer service
Nurse Navigator - Professional Medical Oncology * Days - 40hrs/wk.
University of Michigan Health-West —Wyoming, MI
- Full-time
- Nursing
- RN License
- Bachelor of Science
Clinical Pharmacy Specialist GV Internal Medicine Pediatrics
Corewell Health —Greenville, MI
- Part-time
- Hybrid work
- Patient monitoring
- BLS Certification
- Internal Medicine
- Work from home
4d
Pharmacy Billing Specialist III
Guardian Pharamcy of Michigan - Grand Rapids —Grand Rapids, MI
- $23 - $24 an hour
- Full-time
- HIPAA
- Research
- Mid-level
- Health savings account
- AD&D insurance
Quick Apply
Optometric Technician
Pearle Vision - Grandville —Grandville, MI
- Full-time
- High school diploma or GED
- Driver's License
- Travel
Quick Apply

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utilization management jobs near grand rapids, mi

Case Manager (RN) - Case Management * Evenings - 36hrs/wk.

University of Michigan Health-West -
Wyoming, MI

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Job Details

Full-time

Qualifications

RN License
Negotiation

Full Job Description

Case Manager (RN) - Case Management * Evenings - 36hrs/wk.

Requisition #: req11831

Shift: Evenings

FTE status: 0.9

On-call: No

Weekends: Yes

General Purpose of Job:

The Case Manager works in partnership and in a leadership role with physicians and the interdisciplinary team to coordinate the care and service of selected patients across the continuum. This role’s underlying objective is to enhance the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors. The role integrates, coordinates and promotes efficient and effective utilization management, care facilitation and discharge planning functions.

Knowledge, Skills and Experience:

Education:

High school diploma/GED
Bachelor of Science in Nursing preferred

License / Certification / Registration:

Current and valid Michigan R.N. license

Experience:

Minimum of three years clinical nursing experience (acute care preferred)

Skills & Abilities:

Skill and proficiency in applying managed care principles and concepts to the case management process.
Knowledge of and skill in the use of computers and related systems and software preferred.
Skill in observation and critical thinking, demonstrated by effective decision making, and use of appropriate problem-solving methods.
Skill in excellent interpersonal, oral, and written communications required. A high degree of professionalism is essential for all contact with patients, family members, clinical personnel, physicians, outside referral sources, and members of the community.
Ability to make effective decisions, judgments and incorporate problem-solving methods.
Ability to be persistent in working through and/or resolving issues and problems required.
Ability to work independently and professionally, set priorities and take initiative while working efficiently and using good judgment required.

Essential Duties:

This job description is intended to cover the minimum essential duties assigned on a regular basis. Team members may be asked to perform additional duties as assigned by their leader. Leadership has the right to alter or modify the duties of the position.

Utilization Management:

Applies approved clinical appropriateness criteria for assigned patients to monitor appropriateness of admissions and continued stays, and documents findings accordingly based on policy. Evaluates for appropriate setting and level of care.
Refers inappropriate observation or anticipated admission cases to the Physician Advisor.
Explores strategies to reduce length of stay and resource consumption while maintaining optimal patient outcomes. Takes action to achieve continuous improvement in both areas.
Obtains certification for unscheduled/emergency admissions, as directed by health plan. Negotiates with payors to get coverage for out-of-plan services.
Collaborates with providers and ancillary departments to arrange the most cost-effective treatment plan.
Reviews medical record for issues related to quality, risk management and appropriate utilization of services.
Identifies potential denials or “No Bills” and develops a plan of action to address the issue with the Supervisor of Case Management.
Functions as a resource for the principles of the managed care process for physicians and other disciplines and promotes case management through role modeling and education of the healthcare delivery team as related to the appropriate disposition for the patient.

Discharge Planning:

Assists with social work to coordinate/facilitate patient care progression throughout the continuum.
Coordinates discharge plan with patient, family, physicians and inpatient/outpatient staff to assure an individualized, timely and effective transition to the next level of care. Continues to monitor and assess for discharge planning needs as appropriate.
Collaborates and communicates with all members of the multidisciplinary team in all phases of discharge planning process; including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching and ongoing evaluation.
Monitors and evaluates effectiveness of the discharge planning process through outcome analysis across the continuum as appropriate.
Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge. Addresses/resolves system problems impeding diagnostic or treatment progress. Proactively identifies and resolves delays and obstacles to discharge.
Facilitates referrals and transfers to other facilities and resource needs as appropriate.
Ensures that all elements critical to the plan of care have been communicated to the patient/family and members of the healthcare team and are documented as necessary in the medical record to assure continuity of care.
Participates in daily multidisciplinary rounds.

Clinical Performance Improvement:

Assists in the collection and reporting of resource and financial indicators including case mix index, LOS, avoidable days, readmission rates, denials and appeals.
Collects delay and other data for specific performance and /or outcome indicators as determined by the Director of Care Management.
Uses data to drive decisions and plan/implement performance improvement strategies related to case management for assigned patients, including fiscal, clinical and patient satisfaction data.
Collaborates with medical staff, nursing staff and other members of the organization to eliminate barriers to efficient delivery of care in the appropriate setting.
Supports and assists in facilitation of appropriate clinical documentation efforts.

Other:

Predictable and reliable attendance.
Performs other duties as assigned. These may include but are not limited to: Maintaining a current knowledge base of department processes, protocols and procedures, pursuing self-directed learning and continuing education opportunities, and participating on committees, task forces, and work groups as determined by management.

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Refine Your Search

utilization management jobs in grand rapids, mi

Case Manager (RN) - Case Management * Evenings - 36hrs/wk.

Vice President, Care Management, Utilization Management & Operations - Priority Health

Licensed Therapist - VA First Responder Program

RN Med Surg

RN Med Surg

Lead Dental Assistant

RN Med Surg

RN - Behavioral Health - Mental Health (Varied)

Registered Nurse - Transfer Coordinator

Social Work Navigator

RN Care Manager - Care Management at Home Program

Health Information Management Supervisor

Registered Nurse - Transfer Center Coordinator

Emergency Care Technician - Emergency Department * Nights (7p-7a) - 36hrs/wk

Senior Operations Specialist Clinical Standardization

Emergency Care Technician - Emergency Department * Evenings (7p-7a) - 24hrs/wk

Nurse Navigator - Professional Medical Oncology * Days - 40hrs/wk.

Clinical Pharmacy Specialist GV Internal Medicine Pediatrics

Pharmacy Billing Specialist III

Optometric Technician

I want to receive the latest job alert for utilization management in grand rapids, mi

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