Utilization review nurse jobs in Pontiac, MI - 78 jobs

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career! Are you an experienced RN Utilization Review Nurse looking for a new opportunity with a prestigious healthcare company as a RN Utilization Review Nurse. Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions - this is the RN Utilization Review Nurse position for you! Company Job Description/Day to Day Duties: Providing utilization review for the Medicaid and Medicare line of business. Primarily inpatient, skilled nurses facilities, rehab, behavioral health, and home healthcare. Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines Provider appeals and Utilization reviews and assist with Denial Letters Provides concurrent review and prior authorizations (as needed) according to policy for members as part of the Utilization Management team. Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures. Participates in interdepartmental integration and collaboration to enhance the continuity of care for members including Behavioral Health and Long Term Care. Hours for this Position: Mon-Fri: 8:30am - 5pm Advantages of this Opportunity: Great salary between $33 - 37! Great benefits!!! Fun and positive work environment! Qualifications Minimum Education/Qualifications/Licensures: Must be an RN Utilization Review background in either Managed Care of Provider environment (at least one year) Interqual experience (at least one year) Also has a background in patient, skilled nurses facilities, rehab, and home healthcare. Other basic computer skills necessary: Microsoft Office, Data Entry, etc. Minimum 2-4 years of clinical practice. Preferably hospital nursing, utilization management, and/or case management. Great typing and data entry skills Additional Information Interested in being considered? If you are interested in being considered for this position, please click the apply button below. Or call John Wood 407-478-0332 ext 225

Formulary Strategy & Utilization Review Pharmacist Shape the drug benefit landscape-analyze and optimize medication use. Key Responsibilities: Review prescribing trends and propose cost-saving alternatives. Maintain evidence-based formularies across multiple payers. Conduct retrospective DUR and prepare stakeholder reports. Qualifications: PharmD with managed care, DUR, or pharmacy benefit experience. Strong Excel/data analytics background preferred. Understanding of clinical guidelines and P&T processes. Why Join Us? Join a top-tier managed care team Hybrid flexibility Strategic and data-driven focus

Advantmed is a leading provider of risk adjustment, quality improvement and value-based solutions to health plans and providers. We drive market leading performance with integrated technology, service, and program solutions that optimize the risk and quality performance of our partners. Our solutions focus on identifying, managing, and documenting risk and quality performance, and the proactive clinical engagement of high acuity populations. The building B.L.O.C.K.S. of our team's success! Bring the fun Leverage together for better Outperform yourself Care at every touchpoint Keep your word. Keep it real Stay curious & listen well Primary Purpose: We are proud of the quality care we provide members, and our team is rapidly expanding to meet the demands of our growing business; we are seeking a highly skilled and compassionate certified Nurse Practitioner to join our Advantmed provider network. In this role, you will be responsible for conducting in-home wellness risk adjustment assessments for Medicare members and other at-risk populations. Your primary objective will be to assess the overall health and well-being of member beneficiaries to ensure accurate and comprehensive risk adjustment coding, leading to greater value-based care. This role is 1099 (PRN) and offers tremendous flexibility and opportunity for those who are balancing competing priorities. Learn more about our primary purpose here Follow us on LinkedIn: ****************************************** NP Responsibilities: In-home Clinical Assessments Travel to members' homes and conduct comprehensive health evaluations Conduct Annual Wellness Visits and health assessments for members with chronic conditions. Perform: Medical history and physical examinations Review of systems Vital signs collection Medication review and reconciliation Possible preventive health screenings Hemoglobin A1C Spirometry KED (Kidney Health Evaluation) DRE (Diabetic Retinal Exam) FIT Patient Education & Engagement Deliver preventive health education and counseling opportunities. Educate patients on ongoing health monitoring, medication adherence, and chronic condition management. Support informed decision-making and ensure true, informed consent. Engage in goals of care discussions when appropriate. Care Coordination & Quality Support Identify clinically relevant diagnoses for care management and risk adjustment documentation. Communicate findings used to generate post visit summaries for the primary care provider. Identify and help close quality care gaps (e.g., screenings, labs, follow-ups). Collaborate enthusiastically with the broader care team to enhance clinical quality and patient experience. Compliance & Professional Standards Adhere to HIPAA regulations and safeguard protected health information (PHI). Maintain accurate, timely, and compliant EMR documentation. Perform additional duties as assigned in alignment with organizational goals. An enthusiastic collaborator contributing to the enhancement of care delivery Providers are expected to commit a minimum of 30 hours per month Locations: Genesee County, Michigan Requirements Travel Requirements Daily travel expectations remain within a 55-mile radius of the assigned home location. NP Qualifications: Must have a valid unencumbered NP License for the state you will be working in This role requires travel up to a maximum 55-mile radius originating in the assigned job posting county Preference is given to weekday schedules Preference is given to standard working hour schedules Previous in-home risk assessment experience preferred Previous 1099 (PRN) experience is preferred but not required 3 years patient care experience preferred (primary care/adult/geriatric, EMR) May be requested to obtain additional NP licensure supported by Advantmed Access to reliable transportation that will enable you to travel to members' homes within a designated area Strong ability to work within our EMR system Ability to work independently Bilingual is a plus Benefits Advantmed offers: Competitive compensation of ~$100 per completed in-home health assessment Paid mileage Flexible work schedule, choose your own schedule No on call Visits ready to be scheduled immediately Appointment confirmation support Dedicated coordinator support Advanced member scheduling coverage State of art technology

Travel within Wayne and Macomb county. The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. **Duties:** Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or members needs to ensure appropriate administration of benefits Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures **Experience:** · Clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required. · Healthcare and/or managed care industry experience. · Case Management experience preferred-- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding · Effective communication skills, both verbal and written. · Ability to multitask, prioritize and effectively adapt to a fast paced changing environment · Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer. · Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. · Typical office working environment with productivity and quality expectations **Education:** · RN with current unrestricted state licensure. · Case Management Certification · CCM preferred **Skills:** **About US Tech Solutions:** US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit *********************** . US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Job Title Transitional Nurse Liaison (Lapeer, Port Huron) Additional Location(s) Employee Type Employee Working Hours Per Week 40 Job Description At Residential Home Health and Hospice ('Residential'), we're looking to add to our extraordinary care team. Grounded by our belief that outstanding care is best delivered in a team-based environment, our Transitional Nurse Liaison (TNL) will partner with our field staff and leaders to provide the best support to the patients that we serve. With our 20-year track record, Residential is a strong leader in the industry. We are consistently named a Top Workplace by our employees and genuinely care where you are in your career path. Our high value rewards package: * Up to 22 paid holiday and personal days off in year one * DailyPay: Access your money when you want it! * Industry-leading 360 You benefits program * Company paid emotional health and wellness support for you and your family * Adoption assistance * Access to Ramsey SmartDollar Certain benefits may vary based on your employment status. What you'll do in this role: * Responsible for obtaining complete/accurate demographic information, medical history including diagnosis for care and primary care physician information. * Responsible for introducing Company to the patient/caregiver, explaining scope of our services, skilled services requested and coordinating start of care visit. * Community Education as requested by our sales to physician offices, assisted living facilities, including but not limited to educational in-services, blood pressure clinics and health fairs. * Patient education at bedside, arranging post discharge physician follow up appointments, sharing important discharge information with the primary care physician. We are looking for a compassionate Transitional Nurse Liaison (TNL) with: * Must have LPN or RN Licensure in good standing. * Minimum of one (1) year of experience in an acute care setting. * Minimum of one (1) year of experience in a customer service capacity. We are an equal opportunity employer and value diversity at our company. NOTICE: * Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana. * By supplying your phone number, you agree to receive communication via phone or text. * By submitting your application, you are confirming that you are legally authorized to work in the United States. Residential Home Health and Residential Hospice is an Equal Opportunity Employer

At Residential Home Health and Hospice (‘Residential'), we're looking to add to our extraordinary care team. Grounded by our belief that outstanding care is best delivered in a team-based environment, our Transitional Nurse Liaison (TNL) will partner with our field staff and leaders to provide the best support to the patients that we serve. With our 20-year track record, Residential is a strong leader in the industry. We are consistently named a Top Workplace by our employees and genuinely care where you are in your career path. Our high value rewards package: Up to 22 paid holiday and personal days off in year one DailyPay: Access your money when you want it! Industry-leading 360 You™ benefits program Company paid emotional health and wellness support for you and your family Adoption assistance Access to Ramsey SmartDollar Certain benefits may vary based on your employment status. What you'll do in this role: Responsible for obtaining complete/accurate demographic information, medical history including diagnosis for care and primary care physician information. Responsible for introducing Company to the patient/caregiver, explaining scope of our services, skilled services requested and coordinating start of care visit. Community Education as requested by our sales to physician offices, assisted living facilities, including but not limited to educational in-services, blood pressure clinics and health fairs. Patient education at bedside, arranging post discharge physician follow up appointments, sharing important discharge information with the primary care physician. We are looking for a compassionate Transitional Nurse Liaison (TNL) with: Must have LPN or RN Licensure in good standing. Minimum of one (1) year of experience in an acute care setting. Minimum of one (1) year of experience in a customer service capacity. We are an equal opportunity employer and value diversity at our company. NOTICE: Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana. By supplying your phone number, you agree to receive communication via phone or text. By submitting your application, you are confirming that you are legally authorized to work in the United States. Residential Home Health and Residential Hospice is an Equal Opportunity Employer

Travel OR RN is needed for 13 weeks to start ASAP in a facility in Michigan. 2+ years of OR experience is required. BLS is required. Shifts consist of Every weekend Friday, Saturday, and Sunday. 7pm-7:30am. EMR used is paragon. Must be able to Circulate. Must be experienced with Ortho, General, GYN, Urology, and Neuro is required. Experience with Pediatric-Geriatric populations is required. Trauma Level 2 experience is highly preferred. Number of Operating rooms: 7 suites. Cases: All areas of surgical specialties are represented, except open-heart surgery. To speak with a recruiter please call Ventura Medstaff today at **************.

Certified Student Support Services/School Nurse District: Oak Park Schools Attachment(s): District Nurse.pdf

Integro Asset Management is a management company that specializes in the areas of skilled nursing, assisted living, and memory care in senior living communities located in various states located across the US. Integro's goal is provides a serene setting and compassionate care to our senior living and memory care residents. At Integro we are dedicated to Enhancing Quality of Life. We are looking for an experienced Quality Assurance Nurse to serves as an integral part of the multidisciplinary team overseeing all quality related activities across the health care setting. This will be a remote position that will require travel. General Purpose The Regional Quality Assurance Nurse serves as an integral part of the multidisciplinary team overseeing all quality related activities across the communities. The Regional Quality Assurance Nurse is primarily responsible for providing leadership, support, and direction to multiple healthcare communities. The Regional Nurse oversees all clinical operations of the facilities in their region, ensures that company policies and procedures are carried out and that regulatory compliance standards are being met. The Regional Nurse ensures optimal utilization of resources and compliance with the operating standards of various health care governing and accrediting bodies. The position of Regional Nurse is as much a support role, as it is a leadership role. Regional Nurses work alongside the management teams at each facility to develop and implement processes, identify and resolve issues. The qualifications of a Regional Nurse generally include: Qualifications: Bachelors in Nursing A minimum of five (5) years' experience as a Professional Nurse and maintains a current state license as a Registered Nurse (RN) At least 5 years nursing management experience in assisted living, skilled nursing or long-term care environments Proficiency in computer skills, Microsoft Office (Windows, Outlook, Excel) with the ability to learn new applications Able to travel within a geographic area or on assignments Demonstration of competence in assessment skills and know how to recognize and implement the standards that protect brand integrity through all services knowledge of local, state, and federal regulatory compliance standards and medical practices within the scope of long-term care. Minimum five (5) years experience in the Performance Improvement discipline in a long term care facility with a successful track record and demonstrated progressive management. (preferred) Responsibilities: Works with nursing leadership across facilities to ensure regular clinical competency verification of nursing staff Conducts Root Cause Analyses for clinical adverse events and near miss events; develops action plans to reduce risk of recurrence; follows the progress of these action plans Identifies areas of potential risk and develops systems within the organization to minimize risk of adverse events or negative quality outcomes Conduct annual and complaint survey preparation Performs other duties as requested by leadership team Quality monitoring of services, training, regulatory compliance and implementation of resident care policies, forms and systems Coordinates the development and integration of a "dashboard" for clinical outcomes, critical interventions, cost, utilization, satisfaction, etc. Continuously assesses the organization's compliance with external regulatory bodies Performs all other duties as requested by leadership Members of our team Enjoy: Working with a highly engaged staff Healthy staffing levels Flexible scheduling Career growth Competitive compensation

Physician Assistant or NP credentialed and certified to work in Michigan, with Diabetic experience and insulin pumps for an endocrinology office. Qualifications Experience is a plus

District Nurse JobID: 14075 Certified Student Support Services/School Nurse District: Oak Park Schools

At Estia Health, we're more than just a workplace: we're a community dedicated to enriching lives and making a difference. If you're passionate about aged care and want to be part of something meaningful, then we want to hear from you. Everyday, over 14,000 employees choose to make a difference at Estia Health, sharing a joint purpose to enrich and celebrate the lives of our residents. With 94 homes (and growing), across Queensland, New South Wales, South Australia and Victoria, you will play a part in positively impacting the lives of our residents and their families. Join us in playing a special role in the future of aged care. About the Role A comfort to our residents - being a great nurse is all about how you make people feel. On a typical day, you'll: * Provide clinical care to our residents * Create comprehensive, individual assessments and care plans for new and existing residents * Ensure timely and accurate documentation including AN-ACC and Commonwealth Standards * Provide leadership and supervision to Personal Care Workers and promote a holistic team approach to the delivery of resident care You'll be someone who is empathetic and who's previously worked in an aged care home. You'll also have: * A real desire to make a difference in people's lives * The ability to build and develop rapport with our residents, their families, and visitors * A nursing Diploma and current AHPRA registration * Solid clinical documentation and computer skills Benefits available: * Discounted gym memberships at Goodlife and Fitness First * Retail savings with the Blue Light Card * Discounted car hire * Employee Assistance Program for you and your family * Free Wellbeing App to support your mental and physical health * Novated leasing for vehicles * Workplace banking support * ACN membership discounts for nurses * Discounted health insurance with nib health * Discounted JB HiFi As one of the largest and fastest growing aged care providers in Australia, we need exceptional people to join us on our journey of providing high quality person centered aged care and services. If this is you, Apply now! Estia Health is committed to embracing diversity, equity and inclusion in our workplaces. We encourage applications from people of all ages, cultures (including Aboriginal and Torres Strait Islander peoples), abilities, sexual orientation and gender identities. If you need assistance to participate in our application process, please let us know. Please be advised that we do not accept emailed applications for this position. To apply, simply click the 'Apply' button and follow the instructions provided. Note: All shortlisted applicants will need to pass the required background checks. During the influenza season, all staff are required to provide evidence of a current influenza vaccination. If you are interested in a role, please ensure you apply online, as we do not accept emailed resumes.

Are you ready to take your Travel career to the next level? See places you have not seen before? Ventura's MedStaff tenured Recruiters are here to help you find your ideal contract; with over 50 years of combined experience. Markets have changed, but Ventura MedStaff has maintained a leader in the forefront of Therapy, Allied and Nursing opportunities. Our recruiters are here to help answer your questions and provide you with the most up to date information. Contracts run 8-13 weeks, with 36-40-hour guarantees, flexible start dates, and a mix of schedules. Contact one of our dedicated Recruiters to discuss more details. Ventura MedStaff benefits represent the care and compassion we provide for our clients. • Health, dental, vision, life, disability benefits and 401k • Tax free stipends when applicable • Gym discounts • Weekly pay • $750.00 referral bonus Please apply or contract us at: *********************** or ************

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career! Job Description Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Molina Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines Provider appeals and Utilization reviews and assist with Denial Letters Provides concurrent review and prior authorizations (as needed) according to Molina policy for Molina members as part of the Utilization Management team. Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures. Participates in interdepartmental integration and collaboration to enhance the continuity of care for Molina members including Behavioral Health and Long Term Care. Qualifications Must be an RN Utilization Review background in either Managed Care of Provider environment (at least one year) Interqual experience Other basic computer skills necessary: Microsoft Office, Data Entry, etc. Minimum 2-4 years of clinical practice. Preferably hospital nursing, utilization management, and/or case management. Also has a background in patient, skilled nurses facilities, rehab, and home healthcare. Additional Information Are you an experienced RN looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career In Nursing by joining a rapidly growing company? If you answered “yes" to any of these questions - this is the RN position for you! If you are interested, reach out to me (Krishna) at 321-574-6926 The greatest compliment to our business is a referral.If you know of someone looking for a new opportunity, please pass along my contact information!

Advantmed is a leading provider of risk adjustment, quality improvement and value-based solutions to health plans and providers. We drive market leading performance with integrated technology, service, and program solutions that optimize the risk and quality performance of our partners. Our solutions focus on identifying, managing, and documenting risk and quality performance, and the proactive clinical engagement of high acuity populations. The building B.L.O.C.K.S. of our team's success! Bring the fun Leverage together for better Outperform yourself Care at every touchpoint Keep your word. Keep it real Stay curious & listen well Primary Purpose: We are proud of the quality care we provide members, and our team is rapidly expanding to meet the demands of our growing business; we are seeking a highly skilled and compassionate certified Nurse Practitioner to join our Advantmed provider network. In this role, you will be responsible for conducting in-home wellness risk adjustment assessments for Medicare members and other at-risk populations. Your primary objective will be to assess the overall health and well-being of member beneficiaries to ensure accurate and comprehensive risk adjustment coding, leading to greater value-based care. This role is 1099 (PRN) and offers tremendous flexibility and opportunity for those who are balancing competing priorities. Learn more about our primary purpose here Follow us on LinkedIn: ****************************************** NP Responsibilities: In-home Clinical Assessments Travel to members' homes and conduct comprehensive health evaluations Conduct Annual Wellness Visits and health assessments for members with chronic conditions. Perform: Medical history and physical examinations Review of systems Vital signs collection Medication review and reconciliation Possible preventive health screenings Hemoglobin A1C Spirometry KED (Kidney Health Evaluation) DRE (Diabetic Retinal Exam) FIT Patient Education & Engagement Deliver preventive health education and counseling opportunities. Educate patients on ongoing health monitoring, medication adherence, and chronic condition management. Support informed decision-making and ensure true, informed consent. Engage in goals of care discussions when appropriate. Care Coordination & Quality Support Identify clinically relevant diagnoses for care management and risk adjustment documentation. Communicate findings used to generate post visit summaries for the primary care provider. Identify and help close quality care gaps (e.g., screenings, labs, follow-ups). Collaborate enthusiastically with the broader care team to enhance clinical quality and patient experience. Compliance & Professional Standards Adhere to HIPAA regulations and safeguard protected health information (PHI). Maintain accurate, timely, and compliant EMR documentation. Perform additional duties as assigned in alignment with organizational goals. An enthusiastic collaborator contributing to the enhancement of care delivery Providers are expected to commit a minimum of 30 hours per month Locations: Wayne County, Michigan Requirements Travel Requirements Daily travel expectations remain within a 55-mile radius of the assigned home location. NP Qualifications: Must have a valid unencumbered NP License for the state you will be working in This role requires travel up to a maximum 55-mile radius originating in the assigned job posting county Preference is given to weekday schedules Preference is given to standard working hour schedules Previous in-home risk assessment experience preferred Previous 1099 (PRN) experience is preferred but not required 3 years patient care experience preferred (primary care/adult/geriatric, EMR) May be requested to obtain additional NP licensure supported by Advantmed Access to reliable transportation that will enable you to travel to members' homes within a designated area Strong ability to work within our EMR system Ability to work independently Bilingual is a plus Benefits Advantmed offers: Competitive compensation of ~$100 per completed in-home health assessment Paid mileage Flexible work schedule, choose your own schedule No on call Visits ready to be scheduled immediately Appointment confirmation support Dedicated coordinator support Advanced member scheduling coverage State of art technology

Hospitals on Incredible Health are actively hiring and accepting applications in the Grand Blanc, MI area for the following position: Nurse Case Manager (RN). Nurses with experience in any of the following areas are strongly encouraged to apply: Clinical pathway, Navigator, or Utilization Review. Shift(s) available: day shift, night shift, and mid shift Job types available: full time, part time, and per diem Employer features: Adoption Assistance, Child Care Benefits, Cross training, Disability Insurance, EAP, Family Care Benefits, Health Insurance, Level 2 trauma center, Life Insurance, Medical, Paid Parental Leave, Phone Plan Discount, PTO, Retirement Plan, Tuition Assistance, Union facility, U.S. News best hospital, Visa Sponsorship Qualifications: Bachelor of Science in Nursing (BSN) or higher educational attainment from an accredited program Active and unencumbered Registered Nurse license 1+ years experience in case management, preferably within a healthcare or hospital setting Exceptional interpersonal and communication skills, both written and verbal, to effectively collaborate with medical professionals, patients, and family members Proficiency in electronic health records (EHR) software Responsibilities: Conduct comprehensive assessments of patients, including their medical history, medication, treatment plans, and psychosocial needs Collaborate closely with healthcare providers, patients, and families to develop and implement individualized care plans Monitor and evaluate patient progress, adjusting care plans as needed and communicating any changes to the healthcare team Serve as the main point of contact between the patient and healthcare providers, ensuring seamless communication and care coordination Maintain up-to-date records and case notes, adhering to all confidentiality and compliance standards Benefits: Healthcare coverage: Medical, Dental, Vision 401K Paid Time Off Tuition Assistance Salary: $72,470 to $111,200 /year

Physician Assistant or NP credentialed and certified to work in Michigan, with Diabetic experience and insulin pumps for an endocrinology office. Qualifications Experience is a plus

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career! Company: Molina Healthcare Location: 880 Long Lake Rd Suite 600 Troy, Michigan 48098 Shift: Daytime hours Employment: Contract: 1-2 months (possibility of going longer depending on business needs) Company Job Description/Day to Day Duties: Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Molina Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines Provider appeals and Utilization reviews and assist with Denial Letters Provides concurrent review and prior authorizations (as needed) according to Molina policy for Molina members as part of the Utilization Management team. Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures. Participates in interdepartmental integration and collaboration to enhance the continuity of care for Molina members including Behavioral Health and Long Term Care. Qualifications Minimum Education/Qualifications/Licensures: Must be an RN Utilization Review background in either Managed Care of Provider environment (at least one year) Interqual experience Other basic computer skills necessary: Microsoft Office, Data Entry, etc. Minimum 2-4 years of clinical practice. Preferably hospital nursing, utilization management, and/or case management. Also has a background in patient, skilled nurses facilities, rehab, and home healthcare. Additional Information Apply now for immediate consideration. After applying, a recruiting consultant will contact you for pre-screening. Please provide your best phone number to contact. Thanks and look forward to hearing from you!

Advantmed is a leading provider of risk adjustment, quality improvement and value-based solutions to health plans and providers. We drive market leading performance with integrated technology, service, and program solutions that optimize the risk and quality performance of our partners. Our solutions focus on identifying, managing, and documenting risk and quality performance, and the proactive clinical engagement of high acuity populations. The building B.L.O.C.K.S. of our team's success! Bring the fun Leverage together for better Outperform yourself Care at every touchpoint Keep your word. Keep it real Stay curious & listen well Primary Purpose: We are proud of the quality care we provide members, and our team is rapidly expanding to meet the demands of our growing business; we are seeking a highly skilled and compassionate certified Nurse Practitioner to join our Advantmed provider network. In this role, you will be responsible for conducting in-home wellness risk adjustment assessments for Medicare members and other at-risk populations. Your primary objective will be to assess the overall health and well-being of member beneficiaries to ensure accurate and comprehensive risk adjustment coding, leading to greater value-based care. This role is 1099 (PRN) and offers tremendous flexibility and opportunity for those who are balancing competing priorities. Learn more about our primary purpose here Follow us on LinkedIn: ****************************************** NP Responsibilities: In-home Clinical Assessments Travel to members' homes and conduct comprehensive health evaluations Conduct Annual Wellness Visits and health assessments for members with chronic conditions. Perform: Medical history and physical examinations Review of systems Vital signs collection Medication review and reconciliation Possible preventive health screenings Hemoglobin A1C Spirometry KED (Kidney Health Evaluation) DRE (Diabetic Retinal Exam) FIT Patient Education & Engagement Deliver preventive health education and counseling opportunities. Educate patients on ongoing health monitoring, medication adherence, and chronic condition management. Support informed decision-making and ensure true, informed consent. Engage in goals of care discussions when appropriate. Care Coordination & Quality Support Identify clinically relevant diagnoses for care management and risk adjustment documentation. Communicate findings used to generate post visit summaries for the primary care provider. Identify and help close quality care gaps (e.g., screenings, labs, follow-ups). Collaborate enthusiastically with the broader care team to enhance clinical quality and patient experience. Compliance & Professional Standards Adhere to HIPAA regulations and safeguard protected health information (PHI). Maintain accurate, timely, and compliant EMR documentation. Perform additional duties as assigned in alignment with organizational goals. An enthusiastic collaborator contributing to the enhancement of care delivery Providers are expected to commit a minimum of 30 hours per month Locations: Washtenaw County, Michigan Requirements Travel Requirements Daily travel expectations remain within a 55-mile radius of the assigned home location. NP Qualifications: Must have a valid unencumbered NP License for the state you will be working in This role requires travel up to a maximum 55-mile radius originating in the assigned job posting county Preference is given to weekday schedules Preference is given to standard working hour schedules Previous in-home risk assessment experience preferred Previous 1099 (PRN) experience is preferred but not required 3 years patient care experience preferred (primary care/adult/geriatric, EMR) May be requested to obtain additional NP licensure supported by Advantmed Access to reliable transportation that will enable you to travel to members' homes within a designated area Strong ability to work within our EMR system Ability to work independently Bilingual is a plus Benefits Advantmed offers: Competitive compensation of ~$100 per completed in-home health assessment Paid mileage Flexible work schedule, choose your own schedule No on call Visits ready to be scheduled immediately Appointment confirmation support Dedicated coordinator support Advanced member scheduling coverage State of art technology