Utilization review nurse jobs in Sterling Heights, 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.

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

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

Become a Key Player: MDS Nurse at Pomeroy Living! Are you a meticulous and compassionate RN with a knack for detail and a passion for ensuring quality care? Pomeroy Living is looking for a dedicated and experienced MDS (Minimum Data Set) Nurse to join our exceptional team! In this vital role, you will be the cornerstone of our resident assessment process, coordinating and completing accurate and timely MDS assessments that directly impact individualized care plans and regulatory compliance. If you thrive in a collaborative environment and are committed to excellence in patient care, we invite you to apply! Your Core Responsibilities Include: MDS Assessment Mastery: Expertly coordinate and complete all MDS assessments with precision and punctuality, ensuring full compliance with state and federal regulations. Interdisciplinary Collaboration: Work seamlessly with our diverse interdisciplinary team (nurses, therapists, social workers, etc.) to develop comprehensive and truly individualized care plans that meet each resident's unique needs. Resident & Family Communication: Clearly and compassionately communicate assessment results and care plan details to residents and their families, fostering transparency and involvement in their care journey. Quality Improvement Champion: Actively participate in ongoing quality improvement initiatives, contributing your expertise to enhance our MDS assessment processes and overall resident outcomes. What You Bring (Qualifications): A Current RN or LPN license in the state of Michigan is required. A minimum of two (2) years of proven experience in MDS coordination within a skilled nursing or similar healthcare setting. A strong, in-depth understanding of the entire MDS assessment process and all related state and federal regulations. Exceptional communication and interpersonal skills, allowing you to effectively collaborate and build rapport. A demonstrated ability to work effectively and contribute positively in a dynamic team environment. Excellent problem-solving and decision-making skills, with an eye for detail and accuracy. Your Rewarding Benefits at Pomeroy Living: Paid Time Off: Start accruing from your very first day of orientation! Paid Holidays: Enjoy time off to celebrate. Financial Flexibility: Access up to 50% of your earned pay DAILY! Flexible Scheduling: We support a work-life balance. Company-Paid Life Insurance: For all full-time staff. Comprehensive Health Coverage: Priority Health Medical, Delta Dental, and Vision Insurance. 401(k) Retirement Plan: Invest in your future. Career Advancement Opportunities: Grow your career within the Pomeroy Living family. If you are a dedicated RN or LPN with strong MDS expertise and a commitment to resident-centered care, we encourage you to apply and make a significant difference at Pomeroy Living!

Job Description With two decades of excellence, Kalologie Medspa stands as a premier destination for aesthetic and wellness treatments. Our team of highly trained experts is renowned for their personalized approach, providing safe, effective, and medically-proven treatments that achieve exceptional results. We are proud of our team based culture, with a genuine focus on well-being. As we continue to expand, we remain committed to our core values and a passionate pursuit of excellence. Position Overview: We are seeking experienced Registered Nurses(RN) to perform IV Infusion Therapy at our location inside Club Studio in Troy. You thrive working in a fast-paced environment and are always willing to learn more and strengthen your skills to deliver the best service and results. The ideal candidate would have specialized training in infusion therapy. Key Responsibilities: Prepare and set up the IV infusion. Foster a calming atmosphere and closely monitor the IV administration process. Conduct client consultations to create customized treatment plans and deliver services that meet individual needs and goals. Educate clients on treatment processes, including detailed pre- and post-care instructions. Address client inquiries, respond to their needs, and manage expectations effectively. Ensure client safety and satisfaction throughout all treatments. Promote and suggest relevant retail products and additional services offered by the company. Maintain and sanitize equipment and manage inventory of products. Adhere to established treatment protocols. Keep detailed records, including client charts. Build and maintain a strong client base. Participate in training sessions and meetings as needed. Perform other assigned duties as required. Occasionally travel to other locations for training purposes. Qualifications: Active license as a Registered Nurse (RN), Nurse Practitioner (NP), Physician Assistant (PA) in the state of employment. Minimum of 2 years of relevant experience preferred. Experience in a clinical setting is a plus. Exceptional interpersonal and communication skills, with the ability to effectively interact with clients, colleagues, and managers. Ability to multitask, stay attentive to client needs, and adapt to business requirements. Strong team player with the ability to take initiative and work independently. Availability to work evenings and weekends is required. Kalologie offers a competitive salary with flexible schedules, generous service discounts, and ongoing training opportunities on new techniques, equipment and products. We promote continued growth and development through our rapidly expanding medical aesthetic clinics.

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

Soleo Health is seeking a Per Diem Infusion Nurse to support our infusion patients in the Detroit, MI and surrounding areas. Join us in Simplifying Complex Care! Soleo Health Perks: Competitive Wages Mileage Reimbursement & Paid Drive Time 401(k) with a Match Referral Bonus Paid Time Off Great Company Culture Annual Merit Based Increases Paid Parental Leave Options Affordable Medical, Dental, & Vision Insurance Plans Company Paid Disability & Basic Life Insurance HSA & FSA (including dependent care) Options Education Assistance Program The Position: The Infusion Nurse provides primary patient care for specifically assigned patients to include assessments, care planning, evaluation and education of patients receiving infusion therapy and/or other nursing services in accordance with the care matrices and best practices in the home or alternate site setting. Responsibilities include: Provide the direct care for all assigned patients including initiation and maintenance of all communications with appropriate care team members including pharmacists, prescribers, dietitians, home patient representatives/care partner and any appropriate community resource staff members. Evaluate and education patient/care partner to safely administer the home infusion therapy and provide additional instruction as indicated. Evaluate the home environment where the care is to be provided and identify interventions that may be required to render the home care environment safe and appropriate for the prescribed care. Develop in conjunction with other team members the plan of care and evaluate response to therapy with each encounter. Develop and maintain caseload scheduling via company approved platform per company policy. Communicate any scheduling changes on an as needed basis to appropriate team members. Coordinate care via approved company platform Takes part in the nurse on-call rotation to ensure continuous nursing support services to our customers. Document all communications at time of service as appropriate per Soleo policy. Strong knowledge of therapies provided by Soleo. Work in conjunction with appropriate departments to ensure all required patient documents are completed and returned to the branch office within acceptable timeframe. Ensures timely submission of plan of treatments as required by states guideline. Performs other duties as assigned. Schedule: Must be able to work Per Diem, 20 hours per week, variable schedule to include evenings and weekends as needed Must be knowledgeable of IV access devices to include: IV lines, ports, and administration of Infusion medications Must be able to drive up to 2 hours to see patients as needed (we offer mileage reimbursement and hourly rate of pay- even when driving!) Requirements RN Degree, BSN Preferred Advanced certification in specialty areas of practice (e.g., CRNI, ONS, IgRN) preferred but not required. On-Call Requirement: This position requires participation in an on-call rotation, nights and weekends included, providing as-needed support outside of regular business hours to address urgent issues and ensure continuous operations. Administrative Oversight: Responsible for providing administrative oversight, including monitoring of workflows, ensuring compliance with policies, and managing resources efficiently to meet organizational objectives. Emergency Availability: Must be available to respond promptly to emergencies, ensuring rapid and effective resolution of issues to minimize impact on operations. Availability during non-standard hours, including nights, weekends, and holidays, as required by the nature of the emergency. Minimum 3 years nursing experience with background in infusion therapy preferred. Current nursing license for applicable home state Experience in ICU and/or Cardiac Care preferred. Proficient with Microsoft Outlook and Microsoft Office Suite. Valid state issued driver's license with no significant restrictions on that license. About Us: Soleo Health is an innovative national provider of complex specialty pharmacy and infusion services, administered in the home or at alternate sites of care. Our goal is to attract and retain the best and brightest as our employees are our greatest asset. Experience the Soleo Health Difference! Soleo's Core Values: Improve patients' lives every day Be passionate in everything you do Encourage unlimited ideas and creative thinking Make decisions as if you own the company Do the right thing Have fun! Soleo Health is committed to diversity, equity, and inclusion. We recognize that establishing and maintaining a diverse, equitable, and inclusive workplace is the foundation of business success and innovation. We are dedicated to hiring diverse talent and to ensuring that everyone is treated with respect and provided an equal opportunity to thrive. Our commitment to these values is evidenced by our diverse executive team, policies, and workplace culture. Soleo Health is an Equal Opportunity Employer, celebrating diversity and committed to creating an inclusive environment for all employees. Soleo Health does not discriminate in employment on the basis of race, color, religion, sex, pregnancy, gender identity, national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an organization, parental status, military service or other non-merit factor. Keywords: Nursing, clinic, clinical, IV, patient care, CPR, Acute, outpatient, pharmacy, Emergency room, ICU, home care, internal medicine, GI, neuro, rheumatology, adult, registered nurse, PACU, chronic, home health, Hospice, Acute Care, Critical Care, CRNI, ER, blood products, IVIG, Biologics, TPN, step down, now hiring, hiring now, immediately hiring, hiring immediately, Vascular Access Nurse, Infusion, Specialty Infusion Pharmacy, IV Therapy, IV Infusion, Home Infusion, IV Therapy Administration, Home Infusion Therapy, Specialty Infusion Nursing, Specialty Infusion, RN Clinical Liaison, Infusion Nurse Liaison, CPR+, Alayacare

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.

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

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

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