Utilization review nurse jobs in Troy, MI

*Employment Type:* Full time *Shift:* Night Shift *Description:* 72 hours per pay period 3p-3:30am Great opportunity for a Registered Nurse, RN professional to work in an organization that focuses on treating the whole person, physically, emotionally and spiritually! *What you will do: * Registered Nurse, RN works in a collaborative environment to deliver excellent patient care as part of an interdisciplinary team providing evidenced based medicine and individualized patient care. A Registered Nurse, RN is expected to facilitate all aspects of the patient visit experience. *Employment Type*: Full time *Shift*: Night Shift *Minimum Qualifications: * * Graduation from an accredited professional school of nursing. * Valid RN licensure authorized in the applicable state(s) of practice/employment. * Valid driver's license where required by assignment. * *Position Highlights and Benefits: * * Medical, Dental and Vision Coverage available on your first day * 403b with employer match * Tuition Reimbursement * 100% paid CEU *Our Commitment * Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are 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, veteran status, or any other status protected by federal, state, or local law.

Are you an experienced nurse who wants to remain clinically involved in patient care without being a bedside nurse? Are you organized, efficient, and able to manage your own work with autonomy? MDS nursing at West Bloomfield Health and Rehabilitation Center may be just what you're looking for! At Ciena Healthcare, we take care of you too, with an attractive benefit package including: Competitive pay Life Insurance 401K with matching funds Health insurance AFLAC Employee discounts Tuition Reimbursement You will join an experienced, hard-working team that values communication and strong teamwork abilities. Responsibilities The Care Management Nurse, MDS Nurse works the RAI process and conducts assessments and care plan coordination for those residents assigned Completes the MDS, CAA's and care plans within regulated time frames. Assesses resident through physical assessment, interview and chart review. Discusses resident care needs with care givers, including physician, nursing, social services, therapy, dietary, and activity staff. Reviews information from hospital, consults and outside agencies and uses such information in the completion of the assessment and care planning. Coordinates, identifies, and/or initiates significant change MDS' Is prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintains PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator Remains current with the American Association of Nursing Assessment Coordinators (AANAC) requirements. Qualifications Registered Nurse (RN) AANC certification a plus. RAC-CT Knowledge of the Resident Assessment Instrument (RAI) process, including the principles the Prospective Payment Process (PPS) strongly preferred. Experience as an MDS Nurse About Ciena Healthcare Ciena Healthcare is Michigan's largest provider of skilled nursing and rehabilitation care services. We serve our residents with compassion, concern, and excellence, believing that every one of them is a unique person who deserves our best each day that we care for them. If you have a passion for improving the lives of those around you and working with others who feel the same way, Ciena is the place for you! IND123

Wages based on MDS Experience $15,000 sign on bonus Are you an experienced nurse who wants to remain clinically involved in patient care without being a bedside nurse? Are you organized, efficient, and able to manage your work with autonomy? MDS nursing at Brittany Manor may be just what you're looking for! At Ciena Healthcare, we take care of you too, with an attractive benefits package including: Competitive pay, Life Insurance, 401K with matching funds, Health insurance, AFLAC. In order to make an application, simply read through the following job description and make sure to attach relevant documents. Employee discounts Tuition Reimbursement You will join an experienced, hard-working team that values communication and strong teamwork abilities. Responsibilities: The Care Management Nurse, MDS Nurse works the RAI process and conducts assessments and care plan coordination for those residents assigned. Some responsibilities of the MDS nurse include: Completes the MDS, CAA's and care plans within regulated time frames Assesses resident through physical assessment, interview and chart review Discusses resident care needs with caregivers, including physician, nursing, social services, therapy, dietary, and activity staff Reviews information from hospitals, consults, and outside agencies and uses such information in the completion of the assessment and care planning Coordinates, identifies, and/or initiates significant change MDS Is prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintain PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator Remains current with the American Association of Nursing Assessment Coordinators (AANAC) requirements Qualifications: Registered Nurse, RN AANC certification a plus. RAC-CT Knowledge of the Resident Assessment Instrument (RAI) process, including the principles of the Prospective Payment Process (PPS) strongly preferred Experience as an MDS Nurse About Ciena Healthcare Ciena Healthcare is Michigan's largest provider of skilled nursing and rehabilitation care services. xevrcyc We serve our residents with compassion, concern, and excellence, believing that every one of them is a unique person who deserves our best each day that we care for them. If you have a passion for improving the lives of those around you and working with others who feel the same way, Ciena is the place for you! IND123 signon

Are you an experienced registered nurse (RN) who wants to remain clinically involved in patient care without being a bedside nurse? Are you organized, efficient, and able to manage your own work with autonomy? MDS nursing at Royalton Manor may be just what you're looking for! We will train the right person for the job! At Ciena Healthcare, we take care of you too, with an attractive benefit package including: Competitive pay Life Insurance 401K with matching funds Health insurance AFLAC Employee discounts Tuition Reimbursement You will join an experienced, hard-working team that values communication and strong teamwork abilities. Interested in learning more about this job Scroll down and find out what skills, experience and educational qualifications are needed. Responsibilities The Care Management Nurse, MDS Nurse works the RAI process and conducts assessments and care plan coordination for those residents assigned. Some responsibilities of the MDS nurse include: Completes the MDS, CAA's and care plans within regulated time frames. Assesses resident through physical assessment, interview and chart review. Discusses resident care needs with care givers, including physician, nursing, social services, therapy, dietary, and activity staff. Reviews information from hospital, consults and outside agencies and uses such information in the completion of the assessment and care planning. Coordinates, identifies, and/or initiates significant change MDS' Is prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintains PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator Remains current with the American Association of Nursing Assessment Coordinators (AANAC) requirements. Qualifications Active Registered Nurse (RN) license with the state of Michigan AANC certification a plus RAC-CT Knowledge of the Resident Assessment Instrument (RAI) process, including the principles the Prospective Payment Process (PPS) strongly preferred Experience as an MDS Nurse About Ciena Healthcare Ciena Healthcare is Michigan's largest provider of skilled nursing and rehabilitation care services. xevrcyc We serve our residents with compassion, concern, and excellence, believing that every one of them is a unique person who deserves our best each day that we care for them. If you have a passion for improving the lives of those around you and working with others who feel the same way, Ciena is the place for you! IND123

Are you an experienced nurse who wants to remain clinically involved in patient care without being a bedside nurse? Are you organized, efficient, and able to manage your own work with autonomy? MDS nursing at The Laurels of Bedford may be just what you're looking for! Laurel Health Care Company offers one of the leading employee benefit packages in the industry, including health insurance, 401K with matching funds, paid time off and paid holidays. Do not wait to apply after reading this description a high application volume is expected for this opportunity. When you work with Laurel Health Care Company, you will join an experienced, hard-working team that values communication and strong teamwork abilities. Responsibilities The Care Management Nurse, MDS Nurse works the RAI process and conducts assessments and care plan coordination for those residents assigned. Some responsibilities of the MDS nurse include: Completes the MDS, CAA's and care plans within regulated time frames. Assesses resident through physical assessment, interview and chart review. Discusses resident care needs with care givers, including physician, nursing, social services, therapy, dietary, and activity staff. Reviews information from hospital, consults and outside agencies and uses such information in the completion of the assessment and care planning. Coordinates, identifies, and/or initiates significant change MDS' Is prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintains PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator Remains current with the American Association of Nursing Assessment Coordinators (AANAC) requirements. Qualifications: Registered Nurse (RN) or Licensed Practical Nurse (LPN) AANC certification a plus. RAC-CT Knowledge of the Resident Assessment Instrument (RAI) process, including the principles the Prospective Payment Process (PPS) strongly preferred. Experience as an MDS Nurse or acceptable exemption required About Laurel Health Care Laurel Health Care Company is a national provider of skilled nursing, subacute, rehabilitative, and assisted living services dedicated to achieving the highest standards of care. At The Laurels, caring is more than providing excellent medical and guest services. xevrcyc It's also being a companion, and treating each guest with the utmost dignity, respect and compassion. It's what we call "The Laurel Way of Caring", and it comes from within each one of us. IND123

Job Description Utilization Review Nurse Full-Time - 8A to 4P WHO WE ARE: In 2004, in an ambitious push to bring hospitality back to the hospital, a small group of top Metro-Detroit surgeons decided to create their own surgical hospital; one that provided patients with the best possible care in a small, easy-to-manage environment that truly embraces the best patient experience. Our highly skilled surgeons and staff play a key role in our success rates and becoming the premier center of choice with 30 surgical beds and 6 operating rooms. WHAT WE ARE LOOKING FOR: Role/Position Definition: The Utilization Review (UR) Nurse provides healthcare services regarding admissions, case management, and utilization review to facilitate discharge planning and care coordination for cost-effective quality healthcare. The UR Nurse has the overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity and to assess the patient for transition needs to promote timely throughput, safe discharge, and prevent avoidable readmissions. The UR Nurse integrates national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention. Transition Management promoting appropriate length of stay, readmission prevention, and patient satisfaction. Care Coordination by demonstrating throughput efficiency while assuring care is in the right sequence and appropriate level. Compliance with state and federal regulatory requirement, HFAP accreditation standards, and organization policy. Qualifications/Position Requirements: Education/Experience Associates degree from an accredited school of nursing required, Bachelor's degree in Nursing preferred. 3+ years of case management/UR experience required. Licensure/Certification Current unrestricted RN License from the State of Michigan required. 3. Knowledge, Skills and Abilities Excellent customer services skills necessary in order to deal effectively with various levels of organization personnel, outside customers, and groups. Ability to work autonomously with little direction and be accountable for outcomes. Must possess excellent written and verbal communication skills. Ability to exercise professional judgment and initiative when analyzing problems and recommending solutions. Knowledge of InterQual criteria, government agencies, insurance benefits coverage and DRG/PDPM payment systems. Hospital medical case management/discharge planning experience. Proficient computer skills, including use of Microsoft Office software (Outlook, word and excel) Understanding of Electronic Health Records required Cerner experience preferred. 4. Duties and Responsibilities: Reviews the medical records of all observation, surgical and medical admissions to determine the medical necessity for admission and continued stay, daily. Reviews all requests for elective medical admissions for appropriate utilization and necessary patient-care planning prior to admission. Reviews all requests for elective surgical procedures scheduled to ensure appropriate utilization. Obtains inpatient authorization for surgical patients requiring inpatient stay. Reviews inpatient census, daily, for admission and observation status, and facilitates any updates, as needed. Responsible for preparing UR reports and documents for the Utilization Review Committee. Attends and participates in the UR Committee along with all other committees as directed (i.e., QA, Safety, Nursing). Assists departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement, and claim denials/appeals. Works with staff (physicians, nursing, and patient access) to ensure correct observation/admission orders are written. Continues review of all patients using criteria and determines need for continued hospitalization based upon third-party payer/insurance guidelines. Based on third party payers/insurance guidelines, communicates as required for continued stay review. May include phone, fax, and payer website (i.e. WebDenis). Working knowledge of severity of illness and intensity of service factors that determine alternative levels of care. Collaborates with QAPI Department: Performs quality assessment reviews and studies both concurrently and retrospectively as required by the hospital's QAPI plan, HFAP standards, and third-party payer regulations. Advocates for the patient and hospital with third-party payers to secure appropriate payment for services rendered. Prevents denials and disputes by communicating with third-party payers and documenting relevant information. Files for inpatient and observation appeals as a result of third-party payer denial or obtaining authorization. Establishes and maintains effective communication with all referral sources, insurers, vendors, and patient supplier systems. Interacts, communicates, and intervenes with multidisciplinary healthcare team in a purposeful, goal-directed fashion. Works proactively to maximize the effectiveness of resource utilization. Anticipates, initiates, and facilitates problem resolution around issues of resource use and continued hospitalization and discharge planning. Identifies and reports variances in appropriateness of medical care provided, over/under utilization of resources compared to evidence-based practice and external requirements. This priority includes communicating information through clear, complete, and concise documentation. Consistently maintains a professional commitment to institutions and department's goals and objectives. Demonstrates flexibility to the department's needs in relation to floor and work schedule and any other internal and external demands on the department. Continually shows commitment to the department by extending one's self when the need arises. Assists in reviewing incoming patient referrals, as needed, utilizing InterQual criteria set for admission into rehabilitation units (Sub-acute and Medical). Maintains current knowledge of case management, utilization management, and discharge planning, as specified by federal, state, and private insurance guidelines. Provides applicable patients with Code 44 form prior to discharge when a physician orders an inpatient admission, and the level of care does not meet admission criteria, the hospital may change the status to outpatient only. Provides applicable patients with an official Medicare Outpatient Observation Notice (MOON) form. Under the NOTICE Act, every patient who receives observation services as an outpatient for more than 24 hours must receive an official MOON form. The MOON is a standardized form created by the Centers for Medicare & Medicaid Services (CMS) Assist with arranging post-discharge services, if necessary. Communicate with the clinical staff as needed for clarification of the patient's status and update them on the discharge plan. Provides documentation in a legible manner to maintain the quality of the medical record as it relates to reimbursement guidelines, accuracy, and facility requirements. Participates in meetings, as necessary. Performs all other duties as assigned. OUR COMMITMENT TO OUR STAFF: Health Safety Measures in place for everyone A diverse & inclusive workforce that embraces communication, caring and courtesy Positive onboarding experience Health Insurance plans effective 1st of the month following 30 days Company-paid life insurance Supplemental Life and Disability insurance plans Generous PTO accrual at start of employment Tuition Reimbursement & Continuing Education opportunities 401k with company match Company Events Community discounts And more!

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

**Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. _Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law._ **Work Schedule:** Monday to Friday from 9:00 AM to 5:30 PM EST, with 2-4 late evening shifts per month from 11:30 AM to 8:00 PM EST. The **Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Perform duties telephonically or on-site such as at hospitals for discharge planning. **How you will make an impact:** + Ensures member access to services appropriate to their health needs. + Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. + Implement care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. + Coordinates internal and external resources to meet identified needs. + Monitors and evaluates effectiveness of the care management plan and modifies as necessary. Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. + Negotiate rates of reimbursement, as applicable. + Assists in problem solving with providers, claims or service issues. Assists with development of utilization/care management policies and procedures. **Minimum Requirements:** + Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. + Current unrestricted RN license in applicable state(s) required. + Multi-state licensure is required if this individual provides services in multiple states. **Preferred Experience, Skills, and Capabilities:** + Certification and experience as a Case Manager is preferred. + BS in a health or human services related field preferred. + Experience in telephonic case management, especially for complex and chronic care needs is strongly preferred. + Preferred proficiency with telephonic systems and health information technology. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $76,944 to $115,416. Locations: New York In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

CorsoCare Hospice and Home Health The Nurse Liaison is a sales professional responsible for establishing new accounts and increasing and promoting the companies overall service lines. The Nurse Liaison will be responsible for interacting, building, and expanding relationships with physicians, hospitals, skilled nursing facilities, senior agencies, and other senior communities. The primary focus of the Nurse Liaison is to drive business and support all organizational product lines. This position may require up to 80% regional travel. Required Experience/Skills for Nurse Liaison: Proven sales results and ability to consistently meet sales targets. 3-5 years of sales experience preferred, but not required. Sales or clinical sales background preferred but not required. Strong technical skills in Microsoft Office Suite (Word, Excel, PowerPoint, TEAMS, Outlook) Strong presentation and public speaking skills required. Ability to work under pressure. Entrepreneurial mindset Good communicator, able to articulate product lines and services. Customer and solutions orientated. Thrives in a fast-paced environment while remaining proactive, organized, and energetic. Proven self-starter with the ability to initiate, manage and complete multiple projects while working independently. Must possess high energy and persuasion. Ability to improvise, multi-task and prioritize in a fast paced, always changing environment while maintaining composure. Demonstrates the importance of detail and follow through. Great time management skills Exercises good judgment and sensitivity to confidential and non-routine matters required. Primary Responsibilities for Nurse Liaison: Actively demonstrates company culture and values safety, common beliefs, and a culture of feedback. Promote all CSIG service lines and drive referral business. Seeks new opportunities to expand our growing number of referrals sources. Proven and consistent ability to achieve build and executive results orientated business plans. Establish new account relationships, understand account needs, and nurture account relationship. Provide patient and professional educational services. Work collaboratively with the Transitional Care Navigator to provide support to medical professionals. Consistently engages across business areas to increase understanding, cohesion, efficiencies, and driven results. Performs other tasks as needed. General Working Conditions: While performing the duties of this job, the employee is required to communicate effectively with others, sit, stand, walk and use hands to handle keyboard, telephone, and other equipment and objects. The employee is occasionally required to reach with hands and arms. This position requires the ability to review detailed documents and read computer screens. The employee will occasionally lift and/or move up to 50 pounds. The noise level in the work environment is moderate. Some travel may be required. We have comprehensive benefit packages that include health, dental, vision, 401(k), income protection, and extraordinary work-life benefits. This classification description is intended to indicate the general kinds of tasks and levels of work difficulty that are required of positions given this title and should not be construed as declaring what the specific duties and responsibilities of any particular position shall be. It is not intended to limit or in any way modify the right of any supervisor to assign, direct and control the work of the employees under her/his supervision. The use of a particular expression or illustration describing duties shall not exclude other duties not mentioned that are of a similar kind or level of difficulty. Equal Opportunity Employer #CORSA

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 Description 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 seeking a highly skilled and compassionate 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 and other 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. NP Responsibilities: Perform annual wellness visits and health assessments on a population with chronic conditions Deliver patient health education opportunities Assist in closing quality care gaps (i.e. screenings and labs) An enthusiastic collaborator contributing to the enhancement of care delivery Providers are expected to commit a minimum of 30 hours per month Locations: Oakland County, Michigan Requirements NP Qualifications: Must have a valid unencumbered NP License for the state you will be working in Previous in-home Risk Assessment experience preferred 3 years patient care experience preferred (primary care/adult/geriatric, EMR) Bilingual is a plus Benefits Advantmed offers: Competitive wages (contractor per diem, per completed in-home assessment rate ~$100) Paid mileage Flexible work schedule Evening and weekend availability Dedicated coordinator support Advanced member scheduling coverage State of art technology

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.

Are you an experienced nurse who wants to remain clinically involved in patient care without being a bedside nurse? Are you organized, efficient, and able to manage your own work with autonomy? MDS nursing at West Bloomfield Health and Rehabilitation Center may be just what you're looking for! All potential applicants are encouraged to scroll through and read the complete job description before applying. At Ciena Healthcare, we take care of you too, with an attractive benefit package including: Competitive pay Life Insurance 401K with matching funds Health insurance AFLAC Employee discounts Tuition Reimbursement You will join an experienced, hard-working team that values communication and strong teamwork abilities. Responsibilities The Care Management Nurse, MDS Nurse works the RAI process and conducts assessments and care plan coordination for those residents assigned Completes the MDS, CAA's and care plans within regulated time frames. Assesses resident through physical assessment, interview and chart review. Discusses resident care needs with care givers, including physician, nursing, social services, therapy, dietary, and activity staff. Reviews information from hospital, consults and outside agencies and uses such information in the completion of the assessment and care planning. Coordinates, identifies, and/or initiates significant change MDS' Is prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintains PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator Remains current with the American Association of Nursing Assessment Coordinators (AANAC) requirements. Qualifications Registered Nurse (RN) AANC certification a plus. RAC-CT Knowledge of the Resident Assessment Instrument (RAI) process, including the principles the Prospective Payment Process (PPS) strongly preferred. Experience as an MDS Nurse About Ciena Healthcare Ciena Healthcare is Michigan's largest provider of skilled nursing and rehabilitation care services. xevrcyc We serve our residents with compassion, concern, and excellence, believing that every one of them is a unique person who deserves our best each day that we care for them. If you have a passion for improving the lives of those around you and working with others who feel the same way, Ciena is the place for you! IND123

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!

Job Description 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 seeking a highly skilled and compassionate 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 and other 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. NP Responsibilities: Perform annual wellness visits and health assessments on a population with chronic conditions Deliver patient health education opportunities Assist in closing quality care gaps (i.e. screenings and labs) 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 NP Qualifications: Must have a valid unencumbered NP License for the state you will be working in Previous in-home Risk Assessment experience preferred 3 years patient care experience preferred (primary care/adult/geriatric, EMR) Bilingual is a plus Benefits Advantmed offers: Competitive wages (contractor per diem, per completed in-home assessment rate ~$100) Paid mileage Flexible work schedule Evening and weekend availability Dedicated coordinator support Advanced member scheduling coverage State of art technology

Are you an experienced nurse who wants to remain clinically involved in patient care without being a bedside nurse? Are you organized, efficient, and able to manage your own work with autonomy? MDS nursing at West Bloomfield Health and Rehabilitation Center may be just what you're looking for! At Ciena Healthcare, we take care of you too, with an attractive benefit package including: * Competitive pay * Life Insurance * 401K with matching funds * Health insurance * AFLAC * Employee discounts * Tuition Reimbursement You will join an experienced, hard-working team that values communication and strong teamwork abilities. Responsibilities * The Care Management Nurse, MDS Nurse works the RAI process and conducts assessments and care plan coordination for those residents assigned * Completes the MDS, CAA's and care plans within regulated time frames. * Assesses resident through physical assessment, interview and chart review. * Discusses resident care needs with care givers, including physician, nursing, social services, therapy, dietary, and activity staff. * Reviews information from hospital, consults and outside agencies and uses such information in the completion of the assessment and care planning. * Coordinates, identifies, and/or initiates significant change MDS' * Is prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintains PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator * Remains current with the American Association of Nursing Assessment Coordinators (AANAC) requirements. Qualifications * Registered Nurse (RN) * AANC certification a plus. RAC-CT * Knowledge of the Resident Assessment Instrument (RAI) process, including the principles the Prospective Payment Process (PPS) strongly preferred. * Experience as an MDS Nurse About Ciena Healthcare Ciena Healthcare is Michigan's largest provider of skilled nursing and rehabilitation care services. We serve our residents with compassion, concern, and excellence, believing that every one of them is a unique person who deserves our best each day that we care for them. If you have a passion for improving the lives of those around you and working with others who feel the same way, Ciena is the place for you! IND123

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!

Job Description 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 seeking a highly skilled and compassionate 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 and other 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. NP Responsibilities: Perform annual wellness visits and health assessments on a population with chronic conditions Deliver patient health education opportunities Assist in closing quality care gaps (i.e. screenings and labs) An enthusiastic collaborator contributing to the enhancement of care delivery Providers are expected to commit a minimum of 30 hours per month Locations: Macomb County, Michigan Requirements NP Qualifications: Must have a valid unencumbered NP License for the state you will be working in Previous in-home Risk Assessment experience preferred 3 years patient care experience preferred (primary care/adult/geriatric, EMR) Bilingual is a plus Benefits Advantmed offers: Competitive wages (contractor per diem, per completed in-home assessment rate ~$100) Paid mileage Flexible work schedule Evening and weekend availability Dedicated coordinator support Advanced member scheduling coverage State of art technology

Are you an experienced nurse who wants to remain clinically involved in patient care without being a bedside nurse? Are you organized, efficient, and able to manage your own work with autonomy? MDS nursing at West Bloomfield Health and Rehabilitation Center may be just what you're looking for! At Ciena Healthcare, we take care of you too, with an attractive benefit package including: Competitive pay Life Insurance 401K with matching funds Health insurance AFLAC Employee discounts Tuition Reimbursement You will join an experienced, hard-working team that values communication and strong teamwork abilities. Is your CV ready If so, and you are confident this is the role for you, make sure to apply asap. Responsibilities The Care Management Nurse, MDS Nurse works the RAI process and conducts assessments and care plan coordination for those residents assigned Completes the MDS, CAA's and care plans within regulated time frames. Assesses resident through physical assessment, interview and chart review. Discusses resident care needs with care givers, including physician, nursing, social services, therapy, dietary, and activity staff. Reviews information from hospital, consults and outside agencies and uses such information in the completion of the assessment and care planning. Coordinates, identifies, and/or initiates significant change MDS' Is prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintains PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator Remains current with the American Association of Nursing Assessment Coordinators (AANAC) requirements. Qualifications Registered Nurse (RN) AANC certification a plus. RAC-CT Knowledge of the Resident Assessment Instrument (RAI) process, including the principles the Prospective Payment Process (PPS) strongly preferred. Experience as an MDS Nurse About Ciena Healthcare Ciena Healthcare is Michigan's largest provider of skilled nursing and rehabilitation care services. xevrcyc We serve our residents with compassion, concern, and excellence, believing that every one of them is a unique person who deserves our best each day that we care for them. If you have a passion for improving the lives of those around you and working with others who feel the same way, Ciena is the place for you! IND123