Utilization review nurse jobs in Rochester Hills, MI - 76 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

At Reproductive Medicine Associates of Michigan, we are proud to be one of the top fertility practices in the United States, with a mission to help individuals and couples build their families. For 18 years, our team of dedicated physicians, nurses, and staff has worked together toward the common goal of bringing hope to our patients. We are committed to offering compassionate care, expert advice, and unwavering support when our patients need it most. If you share our passion for helping others and making a meaningful difference in their lives, we invite you to join our exceptional nursing team! Position Overview: As an IVF Nurse, you will play a key role in guiding patients through their fertility treatment journey. You will provide education, coordinate care, and offer emotional support to help patients achieve their dream of starting or expanding their families. Responsibilities: Serve as a Treatment Care Coordinator for fertility patients and couples Case management and clinical treatment of fertility patients Extensive patient education about ART (Assisted Reproductive Technology) and infertility treatments Counsel patients during initial visits regarding treatment options and next steps Communicate physician orders, instructions, and lab results with clear interpretation Perform telephone triage, addressing medication concerns, treatment plans, lab results, and any patient inquiries Ensure exceptional patient care throughout their IVF treatment cycle Shift Information: Start Time: 6:00 AM Schedule: Four 10-hour shifts, with rotating weekends and holidays After one year, enjoy the flexibility of one remote day per week Job Requirements: Specialization in women's health services is preferred Fertility experience is highly desirable Ability to work independently with strong critical thinking skills Must be comfortable working weekends on rotation Strong leadership abilities and a desire to make a lasting impact on patient care Qualifications: Nursing Experience: At least 2 years (required) License: Must hold an active MI RN license (required) Education: Bachelor of Science in Nursing (BSN) is preferred Why Choose Us? Impactful Work: Play a pivotal role in the fertility journey, helping people realize their dream of parenthood. Collaborative Environment: Work alongside a compassionate, dedicated team focused on providing the best care possible. Professional Growth: Opportunities to grow in a supportive, forward-thinking practice, including flexible work arrangements after one year. If you are passionate about reproductive healthcare and committed to providing the highest level of care, we want to hear from you! Apply today and make a difference in the lives of our patients!

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

Part-time Position- FTE 0.5 2-3 days per week/5 days in two week period at various locations Qualifications: Bachelor's degree and current nursing license with the state of Michigan. Registered with the state of Michigan with Licensing and Regulatory Affairs (LARA) as a licensed Registered Nurse. Minimum of three to five years successful Registered Nurse experience, preferably with school age students. Experience with Michigan Care Improvement Registry (MCIR). Preferred CPR, First Aid, and Stop the Bleed certified instructor. Excellent and empathetic communicator. Excellent writing and mathematics ability. Description: Demonstrated ability to train, monitor, document and effectively implement health care plans that potentially are critical and/or chronic. Effectively work with administration in determining the level of support needed for a student for accommodations and IDEA 504 plans. Effectively monitor MCIR and provide assistance to administration in meeting established goals for effectiveness. Provide Professional Development for crisis, emergency, health, wellness, and safety to district staff, students, and community. Coordinate, monitor, and work with local and state agencies for crisis, emergency, health, wellness, and safety needs for the district. Demonstrated rapport with local physicians, hospitals, local and state agencies. Conduct and attend parent meetings. Ability to work exceptionally with our diverse community and professional staff. Perform other duties as assigned. Method: Applicants must apply online at ******************************************** Please scan and upload your cover letter, resume, transcripts, credentials and letters of recommendation to your online application. Paper applications and emails will not be accepted. Posting expires when job is filled. NONDISCRIMINATION: It is the policy of the Utica Community Schools that no person on the basis of race, color, religion, national origin or ancestry, age, sex, marital status or handicap shall be discriminated against, excluded from participation in, denied the benefits of or otherwise be subjected to discrimination by this educational agency. Any persons suspecting a discriminatory practice should contact the Human Resources Department at 11303 Greendale, Sterling Heights, MI 48312 or ************.

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 **************.

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

Responsible for the coordination of the Resident Assessment Instrument (RAI), the electronic transmission of RAI data to the state Bulletin Board in accordance with State and Federal regulations and facility policies. Facilitates communication between the Interdisciplinary Team. Ongoing education of those preparing the M.D.S. Essential Duties & Responsibilities RAI Preparation and Process Schedules completion of RAI following State and Federal guidelines. Notifies Interdisciplinary Team members with distribution of schedules showing dates of assessment schedules. Assists in completion of RAI as needed. Assists with data input into the RAI computer system. Supervises the completion of the RAI by the Interdisciplinary Team. Modification to assessment schedule to ensure appropriate RUG score for each individual resident. Screens each Minimum Data Set (MDS) for accuracy before finalizing, locking, and signing. Transmits RAI data to the state weekly or as needed. I. Tracks Validation Reports, Monthly and Quarterly Reports from the state. II. Medicare Review and Coverage Active interaction with the Interdisciplinary Team in daily conference to evaluate each resident's status and needs relative to Medicare skilled coverage and potential for RUG category changes. Assist Interdisciplinary staff with Medicare review via chart audit in order to ensure that: Change of condition RAIs are initiated when appropriate; Review chart documentation, including nursing and ancillary progress notes, care plans, and CNA notes, reflects the need for the care and services the resident receives; 3. Medicare coverage is discontinued when resident no longer meets criteria. III. Other Duties Develop customized tracking tools and/or forms for interdisciplinary team members (i.e. D.O.N., A.D.O.N., Nurse managers, Social Services) Ensures RAI/MDS software is functioning properly and is in contact with software vendor to ensure that facility is using the most current version of software. Clarification of Medicare Certification/Re-Certification forms for different disciplines. Assist with the completion and maintenance of the Resident Roster and the Census and Condition Reports. Works closely with the state RAI/MDS automation coordinator. Coordinates with the billing department on assessment schedules for effective date of assessments and clarification of billing assessment codes to complete the billing cycle in a timely manner. Utilizes the Internet for research and information gathering for changes in the RAI and Medicare process. Acts as a liaison to the Interdisciplinary Team. H. Performs other duties incidental to the position and as delegated by the Director of Nursing.

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 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: 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 Registered Nurse looking for a new opportunity with a prestigious healthcare company in Troy MI? 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 position for 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