Utilization Review Specialist RN
2 weeks ago
Job Summary:
We are seeking a skilled Utilization Review Specialist Registered Nurse to join our team at McLaren Health Care. As a key member of our healthcare team, you will play a critical role in ensuring that hospital admissions are based on medical necessity and that reimbursement is accurate.
Responsibilities:
- Conduct concurrent reviews of medical records to ensure that admission and continued stay criteria are met and documented.
- Collaborate with the healthcare team to determine the appropriate hospital setting (inpatient vs. outpatient) based on medical necessity.
- Work with case management to expedite patient discharge.
- Maintain current knowledge of hospital utilization review processes and participate in the resolution of retrospective reimbursement issues.
- Assist with monitoring the effectiveness of the utilization management program and identifying areas for process improvement.
Requirements:
- Nursing degree from an accredited educational institution.
- State of Michigan licensure as a Registered Nurse (RN).
- Two years of recent clinical or utilization management experience.
Preferred Qualifications:
- Bachelor's degree in nursing.
- Three years of recent case management or utilization management experience.
Equal Opportunity Employer:
McLaren Health Care is an equal opportunity employer committed to providing employment opportunity without regard to an individual's race, color, age, religion, sex/pregnancy, sexual orientation, gender identity, national origin, disability, veteran status, genetic information, or any other status prohibited by applicable laws.
-
Utilization Review Specialist RN
2 weeks ago
Bay City, Michigan, United States McLaren Health Care Full timeJob SummaryWe are seeking a skilled Utilization Review Specialist RN to join our team at McLaren Health Care. As a key member of our healthcare team, you will play a critical role in ensuring that hospital admissions are based on medical necessity and that reimbursement is accurate.Key ResponsibilitiesConduct concurrent reviews of medical records to ensure...
-
Medical Authorization Specialist
4 weeks ago
Garden City, Michigan, United States Orlin & Cohen Medical Specialist Group Full timeJob Title: Medical Authorization RepresentativeOrlin & Cohen Medical Specialist Group is seeking a highly skilled Medical Authorization Representative to join our team. As a Medical Authorization Representative, you will play a critical role in obtaining authorizations for various medical procedures and departments.Key Responsibilities:Initiate requests for...
-
Property Field Claim Specialist
1 day ago
Bay City, Michigan, United States The Auto Club Group Full timeJob Title: Property Field Claim SpecialistWe are seeking a highly skilled Property Field Claim Specialist to join our team at The Auto Club Group. As a Property Field Claim Specialist, you will be responsible for handling complex claims, reviewing assigned claims, and ensuring all possible policyholder benefits are identified.Key Responsibilities:Review...
-
Property Field Claim Specialist
2 weeks ago
Bay City, Michigan, United States The Auto Club Group Full timeJob Title: Property Field Claim SpecialistWe are seeking a highly skilled Property Field Claim Specialist to join our team at The Auto Club Group. As a Property Field Claim Specialist, you will be responsible for handling complex claims, reviewing assigned claims, and ensuring all possible policyholder benefits are identified.Key Responsibilities:Review and...
-
Procurement Specialist
3 weeks ago
Bay City, Michigan, United States Vallen Distribution, Inc. Full timeProcurement SpecialistVallen Distribution, Inc. is seeking a skilled Procurement Specialist to join our team. As a Procurement Specialist, you will be responsible for procuring products and materials that meet the organization's standards of price, quality, timing, and reliability of supply.Key Responsibilities:Perform procurement activities to ensure...
-
Property Field Claim Specialist
14 hours ago
Bay City, Michigan, United States The Auto Club Group Full timeJob Title: Property Field Claim SpecialistWe are seeking a highly skilled Property Field Claim Specialist to join our team at The Auto Club Group. As a Property Field Claim Specialist, you will be responsible for handling complex claims and providing exceptional customer service to our policyholders.Key Responsibilities:Review and analyze complex claims to...
-
Independent Luxury Brand Reviewer
2 weeks ago
Garden City, Michigan, United States CXG Full timeBecome a part of a distinguished network that enhances the customer journey for elite luxury brands globally. CXG, a premier agency specializing in customer experience for high-end brands, is seeking dedicated Customer Experience Reviewers who are current patrons of luxury brands.As an Independent Luxury Brand Reviewer, you will have the opportunity to...
-
Home Care Coding Specialist-Diagnosis
4 weeks ago
Garden City, Michigan, United States Northwell Health Full timeJob Title: Home Care Coding Specialist-DiagnosisWe are seeking a highly skilled and experienced RN - BSN or MSN candidate with a HCS-D - Home Care Coding Specialist-Diagnosis, COS-C Certificate for OASIS Specialist-Clinical to join our team.Job Summary:The successful candidate will be responsible for validating acute inpatient coded charts to ensure the...
-
Home Care Coding Specialist-Diagnosis
3 weeks ago
Garden City, Michigan, United States Northwell Health Full timeJob Title: Home Care Coding Specialist-DiagnosisWe are seeking a highly skilled and experienced RN - BSN or MSN candidate with a HCS-D - Home Care Coding Specialist-Diagnosis, COS-C Certificate for OASIS Specialist-Clinical to join our team at Northwell Health.Job Summary:The successful candidate will be responsible for validating acute inpatient coded...
-
Travel Nurse RN Specialist
1 month ago
Bay City, Michigan, United States Genie Healthcare Full timeTravel Nursing Opportunity with Genie HealthcareWe are seeking a skilled Special Procedures RN to join our team as a travel nurse. This exciting opportunity will allow you to work in a dynamic environment and provide high-quality patient care.Job Requirements:1 year of related experienceSuccessful completion of a Radiologic Technology programRegistered as a...
-
Payroll Specialist
16 hours ago
Reed City, Michigan, United States Utility Supply and Construction Company Full timePayroll Specialist Job DescriptionUtility Supply & Construction Co (USC) is seeking a skilled Payroll Specialist to manage payroll transactions, ensure compliance with regulations, and provide exceptional support to employees.Key Responsibilities:Process payroll transactions, including salaries, benefits, garnishments, taxes, and other deductions and...
-
Travel Nurse RN Specialist
1 month ago
Bay City, Michigan, United States Genie Healthcare Full timeJob OverviewGenie Healthcare is seeking a skilled travel nurse to fill a Special Procedures position in a dynamic healthcare setting.Key Responsibilities:Provide high-quality patient care as a Special Procedures RNCollaborate with interdisciplinary teams to ensure seamless patient careDevelop and implement effective care plans to meet patient needsConduct...
-
Travel Nurse RN PCU Specialist
8 hours ago
Carson City, Michigan, United States OneStaff Medical Full timeJob Title: Travel Nurse RN PCU SpecialistOneStaff Medical is seeking a skilled Travel Nurse RN PCU Specialist to join their team in Carson City, Michigan.Job Requirements:Specialty: PCU - Progressive Care UnitDiscipline: RNDuration: 13 weeksShift: 12 hours, nightsEmployment Type: TravelAs a Travel Nurse RN PCU Specialist, you will be responsible for...
-
Electrical Metering Specialist
3 weeks ago
Bay City, Michigan, United States The City of Bay City, Michigan Full timeJob SummaryThe City of Bay City, Michigan is seeking a highly skilled and experienced Electrical Metering Technician II to join our team. As a key member of our Electric Department, you will be responsible for installing, maintaining, repairing, testing, and calibrating digital solid-state single-phase, poly-phase, time-of-use, and other complex electrical...
-
Electrical Metering Specialist
4 weeks ago
Bay City, Michigan, United States The City of Bay City, Michigan Full timeJob Title: Metering Technician IIJob Summary:The City of Bay City, Michigan is seeking a highly skilled and experienced Metering Technician II to join our team. As a key member of our Electric Department, you will be responsible for installing, maintaining, repairing, testing, and calibrating digital solid-state single-phase, poly-phase, time-of-use, and...
-
Travel Nurse RN ICU Specialist
3 weeks ago
Garden City, Michigan, United States HealthEcareers - Client Full timeJob Title: Travel Nurse RN ICU SpecialistTRS Healthcare is seeking a skilled Travel Nurse RN ICU Specialist to join their team in Garden City, Kansas.Job Description & RequirementsSpecialty: ICU - Intensive Care UnitDiscipline: RNDuration: 13 weeksShift: 12 hours, nightsEmployment Type: TravelTRS Healthcare Job ID #1216350. Pay package is based on 12 hour...
-
Tooling Specialist
2 weeks ago
Bay City, Michigan, United States Shively Diversified Management Services Full timeJob Opportunity: Tooling PresetterWe are seeking a skilled Tooling Presetter to join our team at Shively Diversified Management Services. As a key member of our production team, you will play a crucial role in ensuring the smooth operation of our equipment and the timely completion of projects.Responsibilities:Review and manage the daily schedule to ensure...
-
Electronics Specialist
1 day ago
Reed City, Michigan, United States General Mills Full timeJob Title: Controls SpecialistGeneral Mills, a leading food manufacturer, is seeking a skilled Controls Specialist to join its team at the Reed City plant. As a Controls Specialist, you will play a critical role in maintaining and updating plant electronic communications and controls in various areas, including office spaces, production floors, equipment,...
-
Tooling Specialist
4 weeks ago
Bay City, Michigan, United States Shively Diversified Management Services Full timeJob Opportunity: Tooling PresetterWe are seeking a skilled Tooling Presetter to join our team at Shively Diversified Management Services. As a key member of our production team, you will play a crucial role in ensuring the smooth operation of our equipment and the timely completion of projects.Responsibilities:Review daily schedules and ensure all necessary...
-
Electronics Specialist
4 weeks ago
Reed City, Michigan, United States General Mills Full timeJob Title: Controls SpecialistGeneral Mills, Inc. is a leading manufacturer of beloved foods, including Cheerios, Lucky Charms, and Yoplait yogurt. We are seeking a skilled Controls Specialist to join our team at our Reed City plant in Michigan.About the Role:The Controls Specialist will support the plant and maintenance department in updating and...