Utilization Review Nurse
Troy, MI · On-site
Contract: 1-2 months (possibility of going longer depending on business needs) Company /Day to Day ... Must be an RN Utilization Review background in either Managed Care of Provider environment (at ...
Utilization Review Nurse
Troy, MI · On-site
Contract: 1-2 months (possibility of going longer depending on business needs) Company /Day to Day ... Must be an RN Utilization Review background in either Managed Care of Provider environment (at ...
Utilization Management Reviewer (RN) - Multiple Positions!
Medical
Dental
Retirement
May perform clinical review telephonically, electronically, or on-site, depending on customer and ... contract benefits, and State and Federal Mandates. * May be responsible for pricing, coding ...
Utilization Management Reviewer (RN) - Multiple Positions!
Medical
Dental
Retirement
May perform clinical review telephonically, electronically, or on-site, depending on customer and ... contract benefits, and State and Federal Mandates. * May be responsible for pricing, coding ...
Utilization Management Reviewer (RN) - Multiple Positions!
Dewitt, MI · On-site
Medical
Dental
Retirement
May perform clinical review telephonically, electronically, or on-site, depending on customer and ... contract benefits, and State and Federal Mandates. * May be responsible for pricing, coding ...
Utilization Management Reviewer (RN) - Multiple Positions!
Dewitt, MI · On-site
Medical
Dental
Retirement
May perform clinical review telephonically, electronically, or on-site, depending on customer and ... contract benefits, and State and Federal Mandates. * May be responsible for pricing, coding ...
Utilization Management Reviewer (RN) - Multiple Positions!
Medical
Dental
Retirement
May perform clinical review telephonically, electronically, or on-site, depending on customer and ... contract benefits, and State and Federal Mandates. * May be responsible for pricing, coding ...
Utilization Management Reviewer (RN) - Multiple Positions!
Medical
Dental
Retirement
May perform clinical review telephonically, electronically, or on-site, depending on customer and ... contract benefits, and State and Federal Mandates. * May be responsible for pricing, coding ...
... and Utilization Review (UR) activities across the CMH and SUD provider networks, including case ... contract monitoring Serve as backup to the CCO on the state-wide UM Directors Group Provide ...
... and Utilization Review (UR) activities across the CMH and SUD provider networks, including case ... contract monitoring Serve as backup to the CCO on the state-wide UM Directors Group Provide ...
UTILIZATION MANAGEMENT CLINICIAN
Muskegon, MI · On-site
$34.40 - $43.34/hr
Medical
Dental
Vision
Life
PTO
APPLICANT REVIEW PROCEDURE Any applicant is entitled to a review of any determination or action ... CONTRACT SECTION BENEFIT Medical Insurance Health Savings Account (HSA) Plan 1 Single Plan: $2,500 ...
New
UTILIZATION MANAGEMENT CLINICIAN
Muskegon, MI · On-site
$34.40 - $43.34/hr
Medical
Dental
Vision
Life
PTO
APPLICANT REVIEW PROCEDURE Any applicant is entitled to a review of any determination or action ... CONTRACT SECTION BENEFIT Medical Insurance Health Savings Account (HSA) Plan 1 Single Plan: $2,500 ...
New
RN Case Manager - Utilization Review Nurse Shift: 08:00 - 16:30 Assignment Details: * Contract Length: 12 weeks * Guaranteed Hours: 40 hours per week Requirements: * Active nursing license
RN Case Manager - Utilization Review Nurse Shift: 08:00 - 16:30 Assignment Details: * Contract Length: 12 weeks * Guaranteed Hours: 40 hours per week Requirements: * Active nursing license
Case Manager
Detroit, MI · On-site
$55 - $60/hr
* 13 week contract * REQUIRED: 5+ years case management experience with 2+ years recent acute ... UTILIZATION REVIEW, PSYCHOLOGICAL EXPERIENCE DOES NOT APPLY TO THIS REQUIREMENT.
Quick apply
Case Manager
Detroit, MI · On-site
$55 - $60/hr
* 13 week contract * REQUIRED: 5+ years case management experience with 2+ years recent acute ... UTILIZATION REVIEW, PSYCHOLOGICAL EXPERIENCE DOES NOT APPLY TO THIS REQUIREMENT.
Case Manager
Detroit, MI · On-site
$58 - $60/hr
* 13 week contract * REQUIRED: 5+ years case management experience with 2+ years recent acute ... UTILIZATION REVIEW, PSYCHOLOGICAL EXPERIENCE DOES NOT APPLY TO THIS REQUIREMENT.
Quick apply
Case Manager
Detroit, MI · On-site
$58 - $60/hr
* 13 week contract * REQUIRED: 5+ years case management experience with 2+ years recent acute ... UTILIZATION REVIEW, PSYCHOLOGICAL EXPERIENCE DOES NOT APPLY TO THIS REQUIREMENT.
RN - Case Management
Detroit, MI · On-site
$2.1K/wk
Shift: 08:00 - 16:30 Assignment Details: - Contract Length: 12 weeks - Guaranteed Hours: 40 hours per week Requirements: - Active nursing license - Experience in case management or utilization review ...
RN - Case Management
Detroit, MI · On-site
$2.1K/wk
Shift: 08:00 - 16:30 Assignment Details: - Contract Length: 12 weeks - Guaranteed Hours: 40 hours per week Requirements: - Active nursing license - Experience in case management or utilization review ...
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Conduct supplier business reviews and continuous improvement initiatives. Resolve supplier quality ... Optimize inventory, contract utilization, and procurement processes. Support budget planning and ...
Conduct supplier business reviews and continuous improvement initiatives. Resolve supplier quality ... Optimize inventory, contract utilization, and procurement processes. Support budget planning and ...
Conduct supplier business reviews and continuous improvement initiatives. Resolve supplier quality ... Optimize inventory, contract utilization, and procurement processes. Support budget planning and ...
Conduct supplier business reviews and continuous improvement initiatives. Resolve supplier quality ... Optimize inventory, contract utilization, and procurement processes. Support budget planning and ...
... or Utilization Review Accreditation Commission (URAC) standards. * PGY-1 or PGY-2 Managed Care Pharmacy Residency experience. * Familiarity with Michigan Medicaid MDHHS contract compliance ...
... or Utilization Review Accreditation Commission (URAC) standards. * PGY-1 or PGY-2 Managed Care Pharmacy Residency experience. * Familiarity with Michigan Medicaid MDHHS contract compliance ...
Multiple Openings for Registered Nurse in GRAND BLANC, M
Grand Blanc, MI · On-site
$40 - $50/hr
Schedule Notes: 13 week contract REQUIRED: Minimum 5 years acute inpatient case management ... This position integrates discharge planning, utilization review, and care coordination to promote ...
Quick apply
Multiple Openings for Registered Nurse in GRAND BLANC, M
Grand Blanc, MI · On-site
$40 - $50/hr
Schedule Notes: 13 week contract REQUIRED: Minimum 5 years acute inpatient case management ... This position integrates discharge planning, utilization review, and care coordination to promote ...
Conduct supplier business reviews and continuous improvement initiatives. * Resolve supplier ... Optimize inventory, contract utilization, and procurement processes. * Support budget planning and ...
Quick apply
Conduct supplier business reviews and continuous improvement initiatives. * Resolve supplier ... Optimize inventory, contract utilization, and procurement processes. * Support budget planning and ...
Board-Certified Orthopedic Surgeon
Warren, MI · On-site
$120 - $180/hr
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Board-Certified Orthopedic Surgeon
Warren, MI · On-site
$120 - $180/hr
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... or Utilization Review Accreditation Commission (URAC) standards. * PGY-1 or PGY-2 Managed Care Pharmacy Residency experience. * Familiarity with Michigan Medicaid MDHHS contract compliance ...
... or Utilization Review Accreditation Commission (URAC) standards. * PGY-1 or PGY-2 Managed Care Pharmacy Residency experience. * Familiarity with Michigan Medicaid MDHHS contract compliance ...
... or Utilization Review Accreditation Commission (URAC) standards. * PGY-1 or PGY-2 Managed Care Pharmacy Residency experience. * Familiarity with Michigan Medicaid MDHHS contract compliance ...
... or Utilization Review Accreditation Commission (URAC) standards. * PGY-1 or PGY-2 Managed Care Pharmacy Residency experience. * Familiarity with Michigan Medicaid MDHHS contract compliance ...
... or Utilization Review Accreditation Commission (URAC) standards. * PGY-1 or PGY-2 Managed Care Pharmacy Residency experience. * Familiarity with Michigan Medicaid MDHHS contract compliance ...
... or Utilization Review Accreditation Commission (URAC) standards. * PGY-1 or PGY-2 Managed Care Pharmacy Residency experience. * Familiarity with Michigan Medicaid MDHHS contract compliance ...
Contract Utilization Review information
What are the key skills and qualifications needed to thrive in contract utilization review?
To thrive in Contract Utilization Review, you need a solid understanding of medical terminology, insurance policies, and contract compliance, often supported by a healthcare-related degree or certification in utilization management. Familiarity with utilization review software, electronic medical records (EMR), and knowledge of regulatory standards such as CMS guidelines is essential. Strong analytical thinking, attention to detail, and effective communication skills are crucial for collaborating with care teams and insurers. These abilities ensure reviews are accurate, contracts are properly administered, and patient care meets organizational and payer requirements.
What does a contract utilization review do?
A typical day in Contract Utilization Review involves reviewing patient medical records, ensuring adherence to payer contracts and regulatory standards, and communicating with healthcare providers to validate medical necessity of services. Professionals in this role often collaborate with clinical staff, case managers, and insurance representatives to resolve discrepancies or authorization issues. The work is detail-oriented and deadline-driven, making organizational skills vital. This dynamic position offers significant opportunities to learn more about healthcare regulations and may serve as a stepping stone toward more advanced roles in healthcare administration or compliance.
What is a contract utilization review?
A Contract Utilization Review job involves analyzing and evaluating the usage of contracts to ensure compliance, cost-effectiveness, and efficiency. Professionals in this role review contract terms, monitor vendor performance, and assess utilization data to optimize contract value. They may work in industries such as healthcare, government, or procurement, ensuring that agreements are being properly executed. The goal is to identify areas for improvement, reduce waste, and enhance operational efficiency.
What are the most commonly searched types of Utilization Review jobs in Michigan?
The most popular types of Utilization Review jobs in Michigan are:
What are popular job titles related to Contract Utilization Review jobs in Michigan?
For Contract Utilization Review jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Contract Utilization Review jobs in Michigan look for?
The top searched job categories for Contract Utilization Review jobs in Michigan are:
What cities in Michigan are hiring for Contract Utilization Review jobs?
Cities in Michigan with the most Contract Utilization Review job openings:
Contractor
Re-posted 16 days ago
Job description
Company Description
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
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!
About Healthcare Support
Sourced by ZipRecruiter
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!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.
Industry
Recruiting and staffing services
Company size
201 - 500 Employees
Headquarters location
Maitland, FL, US
Year founded
2003