Utilization Mgmt Coordinator
4 weeks ago
Job Summary
This role includes accountability for utilization review (UR) and may include admission, concurrent, and retrospective reviews. Coordinates activities involved in the certification, recertification, and concurrent appeals process, conducting referrals for 2nd level review, as needed. Ensures timely communication with payers based on adequate and complete documentation received by the physician/provider and utilization reviews. Initiates concurrent appeals to address patient class/status downgrades or clinical denials related to medical necessity.
Essential Functions
- Participates within the department to meet expected objectives and outcomes.
- Meets or exceeds expectations related to behavior and performance. Meets individual and departmental objectives established for Quality, Satisfaction, Growth and Financial Success.
- Conducts timely and accurate utilization reviews, as assigned, using organization-approved UR criteria.
- Works closely with physician advisors and medical staff to ensure appropriate level of care, including obtaining physician orders for patient class changes when needed.
- Refers cases, as defined, for 2nd level medical necessity review.
- Maintains daily contact with payers to obtain authorization and reauthorization information and addresses concurrent denials and/or audit requests.
- Provides UR and clinical documentation is adequate and complies with payer requirements.
- Schedules next review/follow-up reviews as required in accordance with organizational policy and procedure and payer requests.
- Routinely collaborates with the System Clinical Appeals and Revenue Cycle departments to expedite billing and appeals processes.
- Maintains and monitors assigned work queues within the Electronic Medical Record.
Qualifications
- Required Associate's Degree Associates or technical degree.
- Preferred Bachelor's Degree in nursing or related field.
- 2 years of relevant experience 2 years of experience in clinical/hospital setting. Required
- Hospital utilization review/utilization management experience. Preferred
- Clinical appeals experience. Preferred
- LIC-Registered Nurse (RN) - STATE_MI State of Michigan Upon Hire required
Physical Demands
- Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 50 lbs
- Waist to Waist > 5 lbs: Seldom up to 50 lbs
- Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs
- Waist to Overhead > 5 lbs: Seldom up to 5 lbs
- Bilateral Carry > 5 lbs: Seldom up to 25 lbs
- Unilateral Carry > 5 lbs: Seldom up to 10 lbs
- Pushing Force > 5 lbs: Occasionally up to 25 lbs
- Pulling Force > 5 lbs: Occasionally up to 20 lbs
- Sitting: Occasionally
- Standing: Frequently
- Walking: Frequently
- Forward Bend - Standing: Occasionally
- Forward Bend - Sitting: Occasionally
- Trunk Rotation - Standing: Occasionally
- Trunk Rotation - Sitting: Occasionally
- Squat: Seldom
- Stair Climbing: Seldom
- Crawling / Kneeling: Seldom
- Reach - Above Shoulder: Occasionally
- Reach - at Shoulder or Below: Occasionally
- Handling: Occasionally
- Forceful Grip > 5 lbs: Occasionally
- Forceful Pinch > 2 lbs: Occasionally
- Finger/Hand Dexterity: Frequently
- Visual Acuity ¹ [None = No; Seldom = Yes]: Seldom
- Color Vision (Ishihara) Test [None = No; Seldom = Yes]: Seldom
Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
On-demand pay program powered by Payactiv
Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more
Optional identity theft protection, home and auto insurance, pet insurance
Traditional and Roth retirement options with service contribution and match savings
Eligibility for benefits is determined by employment type and status
Primary Location
SITE - Beaumont Service Center - 26901 Beaumont BlvdDepartment Name
Utilization Management - CH EastEmployment Type
Full timeShift
Day (United States of America)Weekly Scheduled Hours
40Hours of Work
8A-430PDays Worked
Monday to FridayWeekend Frequency
N/ACURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
-
RN Mission Control Coordinator
4 weeks ago
Southfield, Michigan, 49034, Kalamazoo County, MI, United States Corewell Health Full timeAbout Corewell HealthOur new name signals our bold commitment to health and wellness. At our core, we are here to help people be well so they can live their healthiest life possible. Through health care and health coverage, we create more value. Through compassion, collaboration, clarity, curiosity and courage, we make anything and everything possible....
-
RN Bed Management
4 weeks ago
Southfield, Michigan, 49034, Kalamazoo County, MI, United States Corewell Health Full time6:00 a.m. to 6:00 p.m.Every 1/3 weekend requirementAbout Corewell HealthOur new name signals our bold commitment to health and wellness. At our core, we are here to help people be well so they can live their healthiest life possible. Through health care and health coverage, we create more value. Through compassion, collaboration, clarity, curiosity and...
-
Administrator ASC
3 weeks ago
Portage, Michigan, 49024, Kalamazoo County, MI, United States Surgery Center of Kalamazoo Full timeSurgery Partners is currently seeking an experienced ASC Administrator to oversee the day-to-day operations of The Surgery Center of Kalamazoo in beautiful Michigan. This multi-specialty ASC is a successful and busy center that has a team of first-class physicians and a cohesive team in place. The Administrator is responsible for assuring that the daily...
-
Land Development Project Manager
3 weeks ago
Grand Rapids, Michigan, 49525, Kent County, MI, United States Meijer Full timeAs a family company, we serve people and communities. When you work at Meijer, you’re provided with career and community opportunities centered around leadership, personal growth and development. Consider joining our family – take care of your career and your community! Meijer RewardsWeekly pay Scheduling flexibilityPaid parental leave Paid education...
-
Master Social Worker
3 weeks ago
Owosso, Michigan, 48867, Shiawassee County, MI, United States Fresenius Medical Care Full timePURPOSE AND SCOPE:Provides psychosocial services to patients treated by the facility including in-center and home dialysis patients (if applicable) utilizing Social Work Theory of Human Behavior and accepted methods of social work practice. Works with the health care team to promote positive adjustment, rehabilitation and improved quality of life for our...
-
RN Registered Nurse
4 weeks ago
Allegan, Michigan, 49010, Allegan County, MI, United States Ascension Full timeDetails Bonus: Up to $12,500Department: Emergency DepartmentSchedule: Full time. 36 hrs/week. Night shift. 7pm - 7:30am. Weekends and holidays per unit rotationHospital: Ascension Borgess AlleganLocation: Allegan, MI Benefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match plans Long-term &...
-
RN Registered Nurse
4 weeks ago
Allegan, Michigan, 49010, Allegan County, MI, United States Ascension Full timeDetails Bonus: Up to $12,500Department: Emergency Department Schedule: Full time. 36 hrs/week. Rotating shift. Primarily days. 7am - 7:30 pm. Every other weekend and holiday. Hospital: Ascension Borgess Allegan Location: Allegan, MI Benefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match...
-
Nurse Navigator Ambulatory Oncology
4 weeks ago
Troy, Michigan, 48007, Oakland County, MI, United States Corewell Health Full timeAmbulatory OncologyScope of workThe Nurse Navigator will assess the patient's individual needs and develop a plan of care to meet those needs. This role includes providing education and support to patients, families, staff and caregivers. The goals of this position include improving patient care and flow, eliminating barriers, and improving the overall...
-
Clinical Social Worker MSW
3 weeks ago
Troy, Michigan, 48007, Oakland County, MI, United States Corewell Health Full timeScope of Work To work collaboratively with members of an interdisciplinary team in order to assist patients and families with complex psychosocial needs. These interventions may include, but are not exclusive to: alternate site coordination, discharge planning, addressing all forms of identified abuse/neglect, adoption, substance use disorders, assisting...
-
Travel RN Case Manager
4 weeks ago
Warren, Michigan, 48093, Macomb County, MI, United States Fusion Medical Staffing Full timeFacility DetailsFacility: Please Contact for facility infoJob DetailsStarts: 03/17/2025Assignment Length: 13Shift: NightsCall Off Policy: Please Contact for InfoJob Quantity: 1Type: TravelJob Description Interested in making a positive impact? You’ve come to the right place. At Fusion Medical Staffing, our goal is to improve the lives of everyone we touch,...
-
RN or LPN Rehab and Nursing Kentridge
3 weeks ago
Ada, Michigan, 49301, Kent County, MI, United States Corewell Health Full timeAbout the unitWith 2 floors and 164 beds we are able to provide care for long term care residents and post-acute rehab patients. Nurse-patient ratios vary depending on the shift and the population you will be serving. It has a long term care unit and a rehab unit. Each floor has designated units that focus on patient specialties, such as general rehab, neuro...
-
RN Ortho Neuro Trauma
4 weeks ago
Farmington Hills, Michigan, 48167, Wayne County, MI, United States Corewell Health Full timeCorewell Health is now offering a $12,000 sign on bonus for this full-time,12-hour night position on 4 South!About the unitThis 48-bed unit is dedicated to ortho/neuro/trauma. Some specific diagnoses’ are total knee, total hip, spinal fusions, and fractured hips. We are Stroke and Trauma certified and complete additional education every three months to...
-
LPN Long Term Care
4 weeks ago
Detroit, Michigan, 48221, Oakland County, MI, United States Corewell Health Full timePost Acute Care UnitsA Wing is a 58 bed Medicare/Medicaid unit that has residents with multiple clinical issues including CHF, dehydration, cellulites, diabetes, DVT, and stable cardiac related issues needing monitoring. Nurses work closely with a variety of health care professionals including: doctors, social work, dieticians, PT/OT, hospice, and spiritual...
-
RN Wound Ostomy
4 weeks ago
Royal Oak, Michigan, 48068, Oakland County, MI, United States Corewell Health Full timeAbout Royal Oak Hospital Recognized by U.S. News & World Report as the #2 hospital in Michigan and one of the top hospitals in the country. It is a major academic and referral center with Level I adult and Level II pediatric trauma designations. The advanced capabilities and clinical expertise within this center have earned it Magnet designation four...
-
LPN Orthopedics Triage
4 weeks ago
Sand Lake, Michigan, 49343, Kent County, MI, United States Corewell Health Full timeAbout the unit Corewell Health Orthopedics, located at 2770 East Beltline Ave Northeast in Grand Rapids is looking for a full time Triage LPN. This position offers a hybrid work model, with the opportunity for some remote work, after successful completion of orientation and training.About Outpatient Clinics Corewell Health operates over 300 outpatient...
-
Information Security Engineer
4 weeks ago
Grand Rapids, Michigan, 49525, Kent County, MI, United States Meijer Full timeAs a family company, we serve people and communities. When you work at Meijer, you’re provided with career and community opportunities centered around leadership, personal growth and development. Consider joining our family – take care of your career and your community! Meijer RewardsWeekly pay Scheduling flexibilityPaid parental leave Paid education...
-
RN Hospice Residence
4 weeks ago
Decatur, Michigan, 49045, Van Buren County, MI, United States Corewell Health Full timeThis is a Weekend Program consisting of working 48 out of 52 weekends.About Corewell Health South HospiceWe are a community based non-profit organization serving 3 counties in Southwest Michigan: Cass, Berrien, and Van Buren for over 30 years. We specialize in providing end of life care and symptom management to individuals with a life expectancy of six...
-
Healthcare Utilization Review Professional
4 days ago
Michigan Center, Michigan, United States LanceSoft Full timeHealthcare Utilization Review Professional: LanceSoft is seeking an experienced Healthcare Utilization Review Professional to join our team. As a Healthcare Utilization Review Professional, you will play a critical role in ensuring the medical necessity of post-acute care services. Your expertise in InterQual and utilization review will enable you to conduct...
-
Utilization Review Nurse
4 weeks ago
Michigan Center, Michigan, United States LanceSoft Full timeJob Description:This position will be remote role for Nurses in Michigan Should have a valid MI RN License Should Have utilization management experience. Should have experience completing post-acute reviews for the inpatient rehab, skilled nursing facility settings previously. The candidate should be well versed in coordination of care activities along with...
-
Clinical Utilization Specialist
3 days ago
Michigan Center, Michigan, United States LanceSoft Full timeLanceSoft is seeking a skilled and experienced Nurse to fill the role of Clinical Utilization Specialist. This is a remote position, ideal for those who value flexibility and autonomy in their work.In this role, you will be responsible for reviewing post-acute care cases, ensuring that patients receive the necessary support and resources to achieve optimal...
-
Utility - 2nd Shift
7 days ago
Michigan Center, Michigan, United States Kable Staffing Full timeJob Description Job Description Kable Staffing is in urgent need of a Utility Associate in Jackson Center, OH. This position is a full-time, temp to hire opportunity. FULL JOB DESCRIPTION PRINCIPAL DUTIES & RESPONSIBILITIESHand pack bottles into containersFold and insert dividers into constructed boxesFold and set-up corrugated traysLoad box makerRemove...
-
Corporate Action Coordinator
3 days ago
Southfield, Michigan, United States Raymond James Full timeAbout the RoleThis Corporate Action Coordinator position is an exciting opportunity to join the Raymond James team. As a key member of our operations team, you will be responsible for supporting the coordination of corporate actions, including mergers, acquisitions, and spin-offs.Key Responsibilities:Develop and maintain accurate records and databases,...
-
Patient Flow Coordinator RN
7 days ago
Southfield, Michigan, United States Corewell Health Full timeRole OverviewThe RN Patient Flow Coordinator plays a critical role in optimizing hospital operations concerning bed management and patient flow. This position provides a comprehensive overview of patient movements within the healthcare system.Develops and implements strategies to improve patient flow and reduce delays.Collaborates with nursing staff and...
-
Renal Care Coordinator
2 days ago
Southfield, Michigan, United States Henry Ford Health System Full timeCompany Overview">Henry Ford Health System is a leading healthcare provider that values excellence and compassion in patient care. As a major academic and clinical center, we strive to deliver innovative and evidence-based treatments.">Job Summary">We are seeking an experienced Registered Nurse to join our Dialysis team as a Renal Care Coordinator. The...
-
Cross-Channel Media Coordinator
5 days ago
Southfield, Michigan, United States Doner Full timeCareer OpportunitiesThe Cross-Channel Media Coordinator role at Doner offers exciting opportunities for career growth and development. We are seeking a highly motivated and organized individual to join our team, with a passion for media and a keen eye for detail. The successful candidate will work closely with the Planning & Strategy Director to develop and...
-
RN Mission Control Coordinator
3 weeks ago
Southfield, Michigan, United States Corewell Health Full timeRN Mission Control Coordinator at Corewell Health summary:The RN Mission Control Coordinator is responsible for overseeing patient flow within hospital operations, ensuring efficient bed utilization and timely movement of patients. This role involves analyzing throughput metrics, collaborating with nursing and multidisciplinary teams, and implementing...
-
RN Mission Control Coordinator
2 weeks ago
Southfield, Michigan, United States Corewell Health Full timeRN Mission Control Coordinator at Corewell Health summary:The RN Mission Control Coordinator plays a crucial role in optimizing patient flow within the hospital by managing bed planning and throughput operations. They collaborate with nursing and physician teams to ensure effective patient movement and utilize analytical skills to identify and mitigate...
-
Coordinator Disability Advocacy Program
2 weeks ago
Southfield, Michigan, United States AmeriHealth Caritas Full timeYour career starts now. We are looking for the next generation of health care leaders.At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national...
-
Intake Social Worker Coordinator
6 days ago
Southfield, Michigan, United States PACE Southeast Michigan Full timeJob Description Job Description Social Worker Intake CoordinatorPolicy:Under the supervision of the Director of Intake and Enrollment, PACE Southeast Michigan (PACE SEMI) SW Intake Coordinator is responsible for the completion of the PACE SEMI intake process including initial home visits and assessments, assistance in obtaining Medicaid documents, and...
-
Special Education Teacher/Coordinator
3 weeks ago
Southfield, Michigan, United States Pace Academy Full timeWe are seeking a Middle School Special Education Teacher/Coordinator. The purpose is to coordinate and facilitate the implementation of curriculum and instruction for content area program for the purpose of increasing students' knowledge, understanding, and skills. If you are passionate, dedicated, and ready to make a lasting impact on young minds, we wants...
-
Special Education Teacher/Coordinator
6 days ago
Southfield, Michigan, United States Pace Academy Full timeJob Description Job Description We are seeking a Middle School Special Education Teacher/Coordinator. The purpose is to coordinate and facilitate the implementation of curriculum and instruction for content area program for the purpose of increasing students' knowledge, understanding, and skills. If you are passionate, dedicated, and ready to make a...
-
rn supports coordinator
5 days ago
Southfield, Michigan, United States Area Agency on Aging 1-B Full timeThe RN Supports Coordinator (SC) uses person-centered principles to perform comprehensive assessments to determine health care, social needs of applicants, and eligibility for the MI Choice Waiver Program. Assess medical, functional, psychological, financial, and environmental needs of applicants. Coordinates support services to assist participants in...
-
RN Patient Flow Coordinator
1 week ago
Southfield, Michigan, United States Corewell Health Full timeAbout Corewell Health At Corewell Health, we are committed to promoting health and wellness for everyone. Our mission is to help individuals live healthier lives through comprehensive healthcare services and coverage. Guided by compassion, collaboration, and innovation, we aim to enhance the community's well-being and ensure everyone has access to resources...
-
RN Mission Control Coordinator
4 weeks ago
Southfield, United States Corewell Health Full timeRequired to work a minimum of every 3rd weekend and holiday rotations outlined in scheduling guidelines.About Corewell Health Our new name signals our bold commitment to health and wellness. At our core, we are here to help people be well so they can live their healthiest life possible. Through health care and health coverage, we create more value....
-
RN Mission Control Coordinator
4 weeks ago
Southfield, United States Corewell Health Full timeNIGHTS: 6:00 p.m. to 6:30 a.m.Required to work a minimum of every 3rd weekend and holiday rotations outlined in scheduling guidelines.About Corewell Health Our new name signals our bold commitment to health and wellness. At our core, we are here to help people be well so they can live their healthiest life possible. Through health care and health coverage,...
-
RN Mission Control Coordinator
4 weeks ago
Southfield, United States Corewell Health Full timeRequired to work a minimum of every 3rd weekend and holiday rotations outlined in scheduling guidelines. About Corewell Health Our new name signals our bold commitment to health and wellness. At our core, we are here to help people be well so they can live their healthiest life possible. Through health care and health coverage, we create more value....
-
RN Mission Control Coordinator
4 weeks ago
Southfield, Michigan, United States Corewell Health Full timeNIGHTS: 6:00 p.m. to 6:30 a.m.Required to work a minimum of every 3rd weekend and holiday rotations outlined in scheduling guidelines.About Corewell HealthOur new name signals our bold commitment to health and wellness. At our core, we are here to help people be well so they can live their healthiest life possible. Through health care and health coverage, we...