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Part Time Insurance Utilization Review Jobs in Michigan

Advantage Health Centers

ORG Seeking Full time or Part-time Psychiatrist. Open Salary, Open Schedule OVERVIEW Under ... utilization reviews; remaining available for emergency consultations. * Maintains historical ...

Trinity Health

Flex Clinical Pharmacist

Brighton, MI · On-site

$113K - $135K/yr

Employment Type: Part time Shift: Rotating Shift Description: Position Purpose A Clinical ... utilization reviews, pharmacoeconomic analysis, and monitors medication therapy outcomes as ...

Great American Insurance Group

Seasonal part-time. Hours fluctuate based on seasonal needs. As a Crop Adjuster, you will ... insurance policies. * Review and evaluates coverage and/or liability. * Secure and analyze ...

LHH US

Part Time Benefits Specialist

Grand Rapids, MI · On-site

$20 - $25/hr

Prepare reports, track program utilization, and maintain documentation related to benefits and ... life insurance, short-term disability, additional voluntary benefits, EAP program, commuter ...

LHH US

Part Time Benefits Specialist

Grand Rapids, MI · On-site

$20 - $25/hr

Prepare reports, track program utilization, and maintain documentation related to benefits and ... life insurance, short-term disability, additional voluntary benefits, EAP program, commuter ...

McLaren Bay Region

Clerk Nursing

Bay City, MI · On-site

Attending required classes and reviews. B. Demonstrating competence in all computer applications. C ... Schedule: Part-time * Requisition ID: 26004340 * Daily Work Times: 19:00pm - 07:30am * Hours Per ...

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All JobsInsurance Utilization Review JobsPart Time Insurance Utilization Review JobsPart Time Insurance Utilization Review Jobs in Michigan

Part Time Insurance Utilization Review information

What is the difference between Part Time Insurance Utilization Review vs Part Time Claims Reviewer?

AspectPart Time Insurance Utilization ReviewPart Time Claims Reviewer
CredentialsTypically requires insurance or healthcare-related certificationsOften requires insurance or claims processing certifications
Work EnvironmentHealthcare settings, insurance companies, or third-party administratorsInsurance companies, claims processing centers, or third-party administrators
Job FocusEvaluating medical necessity and appropriateness of servicesReviewing and processing insurance claims for accuracy and coverage

Part Time Insurance Utilization Review and Part Time Claims Reviewer roles both involve insurance industry work, but focus on different aspects. Utilization review centers on assessing medical necessity, while claims reviewers handle processing and verifying claims. Understanding these differences helps job seekers find the right fit based on their skills and interests.

What are the most commonly searched types of Insurance Utilization Review jobs in Michigan?

The most popular types of Insurance Utilization Review jobs in Michigan are:

What cities in Michigan are hiring for Part Time Insurance Utilization Review jobs?

Cities in Michigan with the most Part Time Insurance Utilization Review job openings:

Part Time Insurance Utilization Review jobs near you

RN Case Manager - Inpatient Case Management - Weekends Only

Henry Ford Health System

Detroit, MI • On-site

Full-time, Part-time

Re-posted 29 days ago

Henry Ford Health rating

7.0

Company rating: 7.0 out of 10

Based on 575 frontline employees who took The Breakroom Quiz

420th of 898 rated healthcare providers

Job description

Part -Time Benefit Eligible

Dedicated to weekends - Saturday and Sunday 8 am - 6:30 pm

On site only.

GENERAL SUMMARY:

The Case Manager-RN plays a pivotal role in coordinating comprehensive patient care, ensuring seamless transitions between care levels. This position requires strong clinical judgment, excellent communication skills, and a deep understanding of healthcare systems. The Case Manager-RN will collaborate closely with patients, families, healthcare providers, and community resources to optimize patient outcomes and promote efficient resource utilization.

Orientation:

Monday through Friday 8 - 4:30 pm for 6 weeks and within those six weeks the new hire will need one weekend orientation consisting of onsite Sat/Sun 7:30-4pm. The new hire will get one day off during the week before Saturday worked, and one day off during the week after for the Sunday worked. It is a full-time during the 6-week orientation that may run a little longer to make sure the new hire is comfortable and able to perform the role independently. Weekends only include SAT and SUN, but there are current opportunities to pick up days.

Key Responsibilities:

Clinical Care Coordination:

  • Conduct comprehensive patient assessments to identify individualized needs and develop personalized care plans.
  • Collaborate with the healthcare team to ensure timely and appropriate interventions, including specialty consultations and referrals.
  • Monitor patient progress, identify potential barriers to care, and implement strategies to address them proactively.
  • Facilitate patient education and support to empower patients and families in their healthcare decisions.

Discharge Planning:

  • Develop and implement comprehensive discharge plans that address the patient's physical, social, and financial needs.
  • Coordinate with community resources and post-acute care providers to ensure a smooth transition of care.
  • Advocate for patients' rights and ensure access to necessary services and support.

Quality Improvement:

  • Analyze patient outcomes and identify opportunities for improvement in care processes.
  • Participate in quality improvement initiatives and contribute to the development of best practices.
  • Stay updated on relevant regulations, guidelines, and industry trends to ensure compliance and optimize care delivery.

Interdisciplinary Collaboration:

  • Collaborate effectively with physicians, nurses, social workers, therapists, and other healthcare professionals to deliver coordinated care.
  • Facilitate communication and information sharing among team members to ensure optimal patient outcomes.
  • Build strong relationships with community partners to support patient needs beyond the hospital setting.

By joining our team as a Case Manager-RN, you will have the opportunity to make a significant impact on the lives of patients and their families. Your expertise in clinical care, discharge planning, and quality improvement will be instrumental in ensuring that patients receive the highest quality care possible.

EDUCATION/EXPERIENCE REQUIRED:

Education:

  • Bachelor's degree in Nursing (BSN) is preferred.
  • Associate's degree in Nursing (ADN) with at least two years of acute care case management experience is acceptable.
  • ADN candidates must enroll in an accredited BSN program within three years of hire and complete it within five years.

Experience:

  • Minimum of three years of recent acute care nursing experience.
  • Prior case management experience is highly preferred.

Certifications:

  • Certification in Case Management (CCM) by the Commission for Case Management Certification or Accredited Case Manager (ACM) by the American Case Management Association is required within one year of hire.

Knowledge and Skills:

  • Strong clinical knowledge and understanding of medical literature and research methodology.
  • Familiarity with financial and reimbursement issues in healthcare.
  • Excellent communication and interpersonal skills, including the ability to collaborate effectively with diverse teams.
  • Strong organizational and time management skills.
  • Proficiency with computers, electronic health records (EHR), database systems, and utilization review/case management documentation systems.
  • Knowledge of CMS, commercial payer requirements, and hospital financial/reimbursement processes is desirable.
  • Demonstrated ability to think critically, solve problems creatively, and plan effectively.
  • Self-direction, flexibility, and the ability to work in a fast-paced environment.

Licenses and Certifications:

  • Registered Nurse (RN) with a valid, unrestricted State of Michigan license.
  • Adherence to Henry Ford Health's Customer Service Policy and standards.

Personal Qualities:

  • Self-direction and commitment to teamwork.
  • Initiative and willingness to learn.
  • Openness to new experiences and respect for diversity.
  • Demonstrated customer service values.

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What Henry Ford Health employees say

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About Henry Ford Health

Sourced by ZipRecruiter

Henry Ford Health provides a full continuum of services from Primary and Preventative care, to Complex and Cpecialty care, Health Insurance, a full suite of home health offerings, Virtual care, Pharmacy, Eye care and other Healthcare retail. It is one of the Nation’s leading Academic Medical Centers, recognized for Clinical excellence in Cancer care, Cardiology and Cardiovascular Surgery, Neurology and Neurosurgery, Orthopedics and Sports medicine, and Multi organ transplants. Consistently ranked among the top five NIH funded institutions in Michigan, Henry Ford Health engages in more than 2,000 research projects annually. Equally committed to educating the next generation of Health Professionals, Henry Ford Health trains more than 4,000 Medical students, Residents and fellows every year across 50+ accredited programs. With more than 33,000 valued team members, Henry Ford Health is also among Michigan’s largest and most Diverse employers, including nearly 6,000 physicians and researchers from the Henry Ford Medical Group, Henry Ford Physician Network and Jackson Health Network.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Detroit, MI, US

Year founded

1915

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