Utilization Management Coordinator
1 week ago
We are seeking a skilled Utilization Management Coordinator to join our team at McLaren USA. This role will play a crucial part in determining hospital settings based on medical necessity, performing concurrent and retrospective utilization management activities, communicating with payors, and obtaining authorization for care.
Key Responsibilities:- Determine hospital settings based on medical necessity in collaboration with the UM RN.
- Conduct concurrent and retrospective utilization management activities to ensure optimal patient care.
- Communicate effectively with payors via phone, fax, and computer system to obtain necessary authorizations.
- Provide prompt feedback regarding payor determinations to facilitate timely decision-making.
- Attend meetings and prepare agendas and minutes to ensure seamless communication.
- Handle office correspondence and phone calls to maintain efficient workflow.
- Perform general office duties, including faxing, copying, and filing, to support administrative tasks.
- An associate degree in a healthcare-related field.
- Two years of clerical experience, preferably in a healthcare environment.
- One year of experience utilizing medical terminology in a healthcare setting.
- A bachelor's degree in coding/medical records/billing or a healthcare-related field.
- Two years of case management or utilization review experience.
- Three years of recent experience in third-party payer certification.
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Clinical Utilization Manager
3 days ago
Detroit, Michigan, United States Detroit Medical Center Full timeAbout the RoleWe are seeking an experienced Clinical Utilization Manager to join our team at the Detroit Medical Center. This is a full-time, day shift position that requires 36 hours of work per week.ResponsibilitiesBalancing clinical and financial requirements and resources in advocating for patient needs with judicious resource managementPromotes prudent...
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Healthcare Utilization Specialist
3 days ago
Detroit, Michigan, United States Detroit Medical Center Full timeThe Detroit Medical Center is seeking a highly skilled Healthcare Utilization Specialist to join our team in Metro Detroit.About the RoleWe are looking for a dedicated professional to facilitate effective resource coordination and ensure that patients receive optimal health care, access to care, and appropriate utilization of resources.This role involves...
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Medical Case Manager
7 days ago
Detroit, Michigan, United States Detroit Medical Center Full timeJob OverviewThe Detroit Medical Center is seeking a highly skilled Medical Case Manager to join our team in Detroit, Michigan. As a key member of our Utilization Review department, you will play a critical role in ensuring that patients receive the most appropriate level of care while maintaining fiscal responsibility.About UsThe Detroit Medical Center is a...
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Medical Director for Utilization Management
5 days ago
Detroit, Michigan, United States Henry Ford Hospital Full timeAt Henry Ford Hospital, excellence in patient care is a top priority. Our team of healthcare professionals strives to deliver high-quality care every day. We encourage collaboration and participation in quality assurance activities, research, and shared governance to make a positive impact on patient outcomes.We utilize evidence-based practice, professional...
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Healthcare Utilization Review Specialist
1 week ago
Detroit, Michigan, United States LanceSoft Full timeJob Title: Healthcare Utilization Review SpecialistWe are seeking a highly skilled and experienced Healthcare Utilization Review Specialist to join our team at LanceSoft.About the Role:Perform thorough reviews of inpatient, outpatient, ambulatory, and ancillary services to ensure medical necessity, appropriate length of stay, intensity of service, and level...
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Healthcare Utilization Specialist
1 week ago
Detroit, Michigan, United States Detroit Medical Center Full timeJob Summary: The Detroit Medical Center is seeking a skilled Healthcare Utilization Specialist to join our team. This role is responsible for ensuring that care provided is at the appropriate level of care based on medical necessity. In this position, you will be responsible for managing the medical necessity process for accurate and timely payment for...
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Healthcare Navigator and Care Coordinator
2 days ago
Detroit, Michigan, United States Wellspring Case Management Full timeJob OverviewWe are seeking a compassionate and organized Medical Case Manager to enhance the quality of our clients' experience by leveraging their knowledge of the medical system.This is an exciting opportunity for a detail-oriented professional to make a positive impact on people's lives while working in a dynamic and collaborative...
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Detroit, Michigan, United States Henry Ford Hospital Full timeAt Henry Ford Hospital, our mission is to deliver exceptional patient care and make a positive impact on the community. As an Advanced Nurse Practitioner in our System Command Center, you will play a vital role in ensuring the quality of healthcare delivery while minimizing financial risk.About the RoleWe are seeking a skilled Registered Nurse with a valid,...
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Medical Office Utilization Specialist
3 days ago
Detroit, Michigan, United States Detroit Medical Center Full timeThe Detroit Medical Center (DMC) is seeking a highly skilled Registered Nurse to fill the role of RN Utilization Review in its esteemed medical office. As a key member of our team, you will play a crucial part in ensuring that patients receive optimal health care and access to necessary resources.With a strong focus on patient-centered care, you will be...
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Healthcare Utilization Specialist
7 days ago
Detroit, Michigan, United States w3r Consulting Full timew3r Consulting is a dynamic and innovative company that values the contributions of its employees.Job SummaryWe are seeking a highly skilled Registered Nurse to join our team as a Healthcare Utilization Specialist. As a key member of our organization, this individual will be responsible for ensuring the appropriateness of inpatient settings utilizing...
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Clinical Utilization Specialist
7 days ago
Detroit, Michigan, United States Detroit Medical Center Full timeThe Detroit Medical Center is seeking a skilled Clinical Utilization Specialist to join their team. In this role, you will play a critical part in ensuring the delivery of high-quality patient care while promoting efficient use of resources.Job DescriptionA career as a Clinical Utilization Specialist at the Detroit Medical Center offers you the opportunity...
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Care Management Coordinator
3 weeks ago
Detroit, Michigan, United States Henry Ford Health System Full timeJob Summary:We are seeking a skilled Care Management Coordinator to join our team at Henry Ford Health System. This is a full-time position that offers a competitive salary of $85,000 - $110,000 per year, depending on experience.About the Role:The Care Management Coordinator will be responsible for coordinating care across the continuum to facilitate quality...
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Radiology Specialist Coordinator
7 days ago
Detroit, Michigan, United States Detroit Medical Center Full timeJob SummaryWe are seeking a skilled Radiology Specialist Coordinator to join our team at the Detroit Medical Center. In this role, you will play a crucial part in coordinating the business operations of our radiology division.Your primary responsibilities will include data analysis and reporting, researching and gathering information, and disseminating it to...
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Detroit, Michigan, United States Harrison Consulting Solutions Full timeJob SummaryHarrison Consulting Solutions is seeking an experienced Electrical Department Manager to lead their Detroit team.About the RoleThis is a leadership position that requires managing departmental work, collaborating with Project Managers on various projects, and overseeing production to ensure QA/QC standards are met. The successful candidate will...
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Medical Care Coordinator
6 days ago
Detroit, Michigan, United States Detroit Medical Center Full timeOverviewThe Detroit Medical Center is a renowned healthcare provider in Southeast Michigan, dedicated to delivering exceptional patient care and innovative medical services.Job SummaryWe are seeking an experienced Medical Care Coordinator to join our team. This role involves facilitating effective resource coordination to help patients achieve optimal...
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Healthcare Utilization Review Specialist
4 days ago
Detroit, Michigan, United States Detroit Medical Center Full timeAbout Detroit Medical CenterThe Detroit Medical Center (DMC) is a leading healthcare provider in Southeast Michigan, renowned for its academic excellence and commitment to patient care. With a rich 150-year history, the DMC operates eight hospitals and over 140 clinics, offering a wide range of services from cardiovascular health to pediatrics.Job SummaryWe...
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Logistics Coordinator Specialist
7 days ago
Detroit, Michigan, United States BioIVT Full timeAbout the RoleWe are seeking a highly organized and detail-oriented Logistics Coordinator to join our team at BioIVT. As a key member of our logistics team, you will be responsible for coordinating the receipt, storage, and shipment of materials and supplies.Responsibilities:Pull customer orders and prepare them for shipment or lab serviceReceive, manifest,...
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Clinical Care Coordinator
7 hours ago
Detroit, Michigan, United States Strategic Staffing Solutions Full timeJob Summary: As a Case Manager RN with Strategic Staffing Solutions, you will lead the coordination of a multidisciplinary team to deliver a holistic, person-centric care management program to a diverse health plan population with a variety of health and social needs. Your key role will be as the single point of contact for members, caregivers, and providers...
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Homeless Shelter Services Coordinator
7 days ago
Detroit, Michigan, United States Neighborhood Service Organization Full timeAbout the Role:">We are seeking a highly skilled Homeless Shelter Services Coordinator to join our team at Neighborhood Service Organization.Job Summary:">The Homeless Shelter Services Coordinator will be responsible for providing essential services to homeless individuals, including intake screening, health and safety checks, crisis intervention, and case...
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Medical Case Manager
6 days ago
Detroit, Michigan, United States Detroit Medical Center Full timeAbout the PositionEstimated Salary: $25,000 Sign on Bonus per year plus salary based on experience.Job OverviewWe are seeking a highly skilled Medical Case Manager to join our team at the Detroit Medical Center. As a Medical Case Manager, you will play a vital role in facilitating care along a continuum through effective resource coordination to help...