Current jobs related to Utilization Management Nurse Specialist - Troy, Michigan - Integra Partners

  • Cost and Utilization Specialist

    4 weeks ago

    Troy, Michigan, United States Oakland Community Health Network Full time

    Job DescriptionJob Title: Cost and Utilization SpecialistJob Summary:The Cost and Utilization Specialist is responsible for analyzing and monitoring all financial activities. This includes budget preparation, developing and monitoring outcomes-based contracting rates, and working with contracted providers on reporting requirements.The Cost and Utilization...

  • Clinical Utilization Specialist

    3 weeks ago

    Troy, Michigan, United States Oakland Community Health Network Full time

    Job SummaryWe are seeking a skilled Clinical Utilization Specialist to promote the effective use of resources in our healthcare network. The ideal candidate will have a strong understanding of clinical care and treatment plans, as well as experience in utilization management.Key Responsibilities:Leverage clinical knowledge and business rules to determine...

  • Energy Management Specialist

    4 weeks ago

    Troy, Michigan, United States Ladgov Corporation Full time

    Job Title: Energy Management SpecialistAt Ladgov Corporation, we are seeking a highly skilled Energy Management Specialist to join our team. As an Energy Management Specialist, you will be responsible for ensuring that utility bills are accurately received and processed for each facility. This includes pulling utility bills from the FileNet program,...

  • Healthcare Utilization Review Specialist LPN

    4 weeks ago

    Troy, Michigan, United States Integra Partners Full time

    Job SummaryIntegra Partners is seeking a skilled LPN/LVN to perform pre-service and post-service utilization reviews and appeals for DMEPOS in a managed care payor environment.This role involves collaborating with our Medical Director to conduct benefit and medical necessity reviews and appeals within an NCQA-compliant UM program.Key ResponsibilitiesPerform...

  • Program Management Specialist

    4 weeks ago

    Troy, Michigan, United States Slate Full time

    Program Management SpecialistSlate is a US company exploring development in the electric vehicle space. We are seeking an experienced Program Management Specialist to join our growing team.This role will be a key enabler in further detailing and implementing Slate's Program Management model by partnering with other teams to define business processes and...

  • Operations UM Training Specialist

    4 weeks ago

    Troy, Michigan, United States Integra Partners Full time

    Job Title: Operations UM Training SpecialistIntegra Partners is seeking an experienced nurse educator to join our Operations Training & Development team as an Operations UM Training Specialist, specializing in Utilization Management (UM) processes.Key Responsibilities:Develop and maintain the UM training curriculum for both administrative and clinical...

  • Paralegal Specialist

    1 month ago

    Troy, Michigan, United States Personnel Management Solutions, Inc. Full time

    Job DescriptionWe are seeking a highly skilled Paralegal Specialist to join our team at a boutique healthcare and probate law firm in Troy. The ideal candidate will have experience in drafting petitions in probate matters, including Guardianships, Conservatorships, Decedent's Estates, and Trusts.The successful candidate will possess excellent communication...

  • Nurse Care Specialist

    4 weeks ago

    Troy, Michigan, United States Trinity Health Full time

    Job Summary:As a Nurse Care Specialist at Trinity Health, you will provide high-quality patient care in a dynamic and supportive environment. Our team is dedicated to delivering exceptional care to our patients, and we are seeking a skilled and compassionate nurse to join our team.Key Responsibilities:• Utilize the Nursing Process to plan, direct, and...

  • Nurse Care Specialist

    4 weeks ago

    Troy, Michigan, United States BAYADA Home Health Care Full time

    Unlock Your Potential as a Nurse Care SpecialistBAYADA Home Health Care is seeking a dedicated and compassionate Nurse Care Specialist to join our team. As a Nurse Care Specialist, you will have the opportunity to make a meaningful difference in the lives of our clients, providing one-on-one care and support in the comfort of their own homes.Key...

  • Nurse Care Specialist

    4 weeks ago

    Troy, Michigan, United States Ciena Healthcare Management, Inc. Full time

    About the Role:Ciena Healthcare Management, Inc. is seeking a skilled and compassionate Licensed Practical Nurse (LPN) to join our team at Regency at Troy. As a LPN, you will work closely with our experienced team to provide high-quality nursing care and rehabilitation services to our valued guests.Responsibilities:Plan, coordinate, and provide nursing care...

  • Nurse Care Specialist

    4 weeks ago

    Troy, Michigan, United States Trinity Health Full time

    Job Summary:As a Nurse Care Specialist at Trinity Health, you will play a vital role in providing high-quality patient care in our 277-bed facility. You will work alongside dedicated Virtual RNs who will assist in documentation, patient monitoring, admissions and discharges, patient education, and so much more for the duration of your shift. Using...

  • Nurse Anesthetist Specialist

    4 weeks ago

    Troy, Michigan, United States Samaritan Hospital Full time

    Job Title: Nurse Anesthetist SpecialistWe are seeking a skilled Nurse Anesthetist Specialist to join our team at Samaritan Hospital. As a key member of our healthcare team, you will be responsible for providing high-quality anesthesia care to patients undergoing surgical procedures.Key Responsibilities:- Administer anesthesia to patients undergoing surgery-...

  • Travel Nurse RN Position in Progressive Care Unit

    4 weeks ago

    Troy, Michigan, United States Travel Nurse Source Full time

    Job Details:Travel Nurse Source is working with Triage Staffing to find a qualified Stepdown RN for a 13-week assignment in a Progressive Care Unit. The position is located in Troy, Ohio, and offers a competitive pay rate of $2,190 per week.About the Position:This is a 12-hour night shift position, working 36 hours per week. The ideal candidate will have...

  • Network Security Specialist

    4 weeks ago

    Troy, Michigan, United States Mindlance Full time

    Job Title: Network Security SpecialistJob Summary:Mindlance is seeking a highly skilled Network Security Specialist to join our team. As a Network Security Specialist, you will be responsible for implementing and maintaining the security of our network infrastructure.Key Responsibilities:Implement and maintain network security protocols and...

  • Project VDC/BIM Specialist

    4 weeks ago

    Troy, Michigan, United States SSOE Full time

    Job SummarySSOE is seeking a highly skilled VDC/BIM Specialist to join our team. As a VDC/BIM Specialist, you will be responsible for developing project execution plans, assisting the Project Manager with requests for proposals and specifications, and utilizing VDC/BIM modeling authoring software such as Plant 3D, Revit, AutoCAD, and Inventor.Key...

  • Benefits and Leave of Absence Specialist

    4 weeks ago

    Troy, Michigan, United States Midland Credit Management Inc Full time

    About the RoleThe Benefits & LOA Specialist plays a crucial role in the execution and continuous improvement of the US Benefits/LOA processes. This position is responsible for managing projects & programs, improving the employees' experience, and operational rigor and excellence throughout our Benefits/LOA processes.Key ResponsibilitiesAssists with the...

  • Clinical Nutrition Specialist Part Time Opportunity in Troy, NY

    3 weeks ago

    Troy, Michigan, United States Trinity Health Full time

    **Clinical Nutrition Specialist Part Time Opportunity in Troy, NY**St. Peter's Health Partners and Trinity Health, a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states, are seeking a part-time Clinical Nutrition Specialist to join their team in Troy, NY.**Job Overview**The Clinical Nutrition Specialist will be...

  • Technical Program Management Specialist

    4 weeks ago

    Troy, Michigan, United States Slate Full time

    About SlateSlate is a US-based company pioneering electric vehicle development. We're seeking a seasoned Technical Program Management Specialist to drive our growth. This role will be instrumental in refining and implementing Slate's Program Management model, collaborating with cross-functional teams to define business processes and drive program excellence....

  • Pain Management Specialist Opportunity in Metro Detroit Area

    4 weeks ago

    Troy, Michigan, United States Archway Physician Recruitment LLC Full time

    Pain Management Specialist OpportunityWe are seeking a skilled Pain Management Specialist to join our team at a state-of-the-art facility in the Metro Detroit area. As a Pain Management Specialist, you will be responsible for providing exceptional care to patients suffering from chronic pain. Our facility is committed to delivering cutting-edge neurosurgical...

  • Benefits and Leave of Absence Specialist

    1 month ago

    Troy, Michigan, United States Midland Credit Management Inc Full time

    About the RoleThe Benefits and Leave of Absence Specialist plays a critical role in ensuring the seamless execution and continuous improvement of our US Benefits/LOA processes. This position is responsible for managing projects and programs, improving employee experience, and enhancing operational rigor and excellence throughout our Benefits/LOA...

Utilization Management Nurse Specialist

1 month ago

Troy, Michigan, United States Integra Partners Full time
Job Summary

We are seeking a highly skilled Utilization Management Nurse to join our team at Integra Partners. As a key member of our team, you will play a critical role in ensuring the efficient and effective management of healthcare services.

Key Responsibilities

  • Conduct thorough reviews of medical necessity and eligibility for DMEPOS services
  • Collaborate with our Medical Director to ensure compliance with NCQA standards and regulatory requirements
  • Develop and implement effective utilization management strategies to optimize healthcare outcomes
  • Communicate with healthcare providers and patients to ensure seamless care coordination
  • Stay up-to-date with the latest medical guidelines and regulatory changes to ensure accurate and informed decision-making

Requirements

  • Active LPN/LVN license
  • Minimum 3 years of nursing experience in an acute or outpatient setting
  • Minimum 2 years of experience in utilization management in a managed care environment
  • Strong analytical and problem-solving skills
  • Excellent communication and interpersonal skills

Benefits

  • Competitive salary and bonus program
  • 401(k) retirement plan with company match
  • Company-paid life insurance and short-term disability coverage
  • Medical, vision, and dental benefits
  • Paid time off and parental leave

Location

We are a remote-friendly company with opportunities available in multiple states, including Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Vermont, and Washington.