RN Health Care Facility Surveyor Greenlife Healthcare StaffingRN Health Care Facility SurveyorMacomb, MIRemote$75,000–$90,000 / yearThe Surveyor will serve as a team member or team leader on various types of surveys (i.e. re-certification, comparative, complaint investigation, and revisits) for long-term care and non-long-term care surveys, which can include; ambulatory surgical centers (ASC), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID), end-stage renal disease (ESRD), Psychiatric Residential Treatment Facility (PRTF), hospital, critical access hospital, and hospice facilities. Impact Recruiting Solutions is currently seeking a RN Health Care Facility Surveyor to fill an opening with a Quality Improvement Consulting Company and will work in a technically exciting environment supporting internal and external customers nationwide.
NewCase Manager-RN Epitec IncCase Manager-RNTroy, MIRemote$36–$39 / hourServing as the primary point of contact for members, caregivers, and providers, this role utilizes telephonic and digital communication channels to assess needs, develop individualized care plans, coordinate services, and improve overall health outcomes across the continuum of care. The Case Manager RN coordinates and leads a multidisciplinary care team to deliver holistic, member-centered care management services for diverse health plan populations with complex medical, behavioral, and social needs.
NewRN Utilization Management Optech, LLCRN Utilization ManagementDetroit, MIRemoteJob Description: Perform prospective, concurrent and retrospective review of inpatient, outpatient, ambulatory and ancillary services to ensure medical necessity, appropriate length of stay, intensity of service and level of care, including appeal requests initiated by providers, facilities and members. Analyze, research, respond to and prepare documentation related to retrospective review requests and appeals in accordance with local, state and federal regulatory and designated accreditation (e.g.
Associate Clinical Editor RELX Group plcAssociate Clinical EditorMichigan, MIRemote$71,600–$119,400 / yearIf performed in Colorado, the base pay range is $71,600 - $119,400.If performed in Illinois, the base pay range is $75,200 - $125,500.If performed in Chicago, IL, the base pay range is $78,700 - $131,400.If performed in Maryland, the base pay range is $75,200 - $125,500.If performed in Ohio, the base pay range is $68,000 - $113,400. Responsibilities: Review, update, and revise assigned content based on scheduled and triggered review cycles, as well as customer needs and requests, and current events in health care such as guideline update under the guidance of a Clinical Editor.
Clinical Retention Specialist (Central - MI, IN, IL, WI, OH, MN, IA, SD, ND) Insulet CorpClinical Retention Specialist (Central - MI, IN, IL, WI, OH, MN, IA, SD, ND)Central, MIRemote$79,300–$118,900 / yearInsulet's flagship innovation, the Omnipod 5 Automated Insulin Delivery System, integrates with a continuous glucose monitor to manage blood sugar with no multiple daily injections, zero fingersticks, and can be controlled by a compatible personal smartphone in the U.S. or by the Omnipod 5 Controller. Identify early indicators of disengagement or churn through data assessment and analytics in partnership with the data science teams and collaborate with Customer Success teams to deploy targeted, regionally informed save strategies.
NewDirector, Integrated Care Team (Ict) Care Coordination Amerihealth Caritas Health PlanDirector, Integrated Care Team (Ict) Care CoordinationSouthfield, MIRemoteRole Overview: The Director, ICT Care Coordination, is responsible for leading the strategic direction, operational execution, and performance of care coordination and population health programs within the assigned market to ensure the delivery of high-quality, compliant, and member-centered clinical and non-clinical services. Education & Experience: Bachelor's degree in Nursing or other health related field with an active, unrestricted Registered Nurse (RN) licensure in MI required plus a Masters Degree or other advanced degree in nursing, social work, health services research, health policy, information technology, or other relevant field.
NewAdvanced RN Analyst - Utilization Management Quality & Training Optech, LLCAdvanced RN Analyst - Utilization Management Quality & TrainingDetroit, MIRemoteThe Advanced RN Analyst is an experienced Utilization Management subject matter expert responsible for quality oversight, auditing, clinical analysis, policy/procedure development, process improvement, and operational support within the Clinical Review department. This role conducts quality audits of RN utilization reviewers, applies InterQual criteria, evaluates compliance with regulatory requirements, analyzes audit results, and identifies opportunities for process improvement.
Director, Integrated Care Team (ICT) Care Coordination AmeriHealth CaritasDirector, Integrated Care Team (ICT) Care CoordinationSouthfield, MIRemoteRole Overview: The Director, ICT Care Coordination, is responsible for leading the strategic direction, operational execution, and performance of care coordination and population health programs within the assigned market to ensure the delivery of high-quality, compliant, and member-centered clinical and non-clinical services. Responsibilities: Partner with the Market Chief Medical Officer (CMO) and other market leaders to develop, execute, and monitor the plan's population health strategy while supporting equitable, whole-person care for members.
Utilization Management Clinician Behavioral Health Night Shift - 4 Days CVS Health CorpUtilization Management Clinician Behavioral Health Night Shift - 4 DaysMIRemote$54,095–$142,576 / yearAbility to manage crisis calls, apply clinical judgment to assess risk, determine support needs, and coordinate appropriate interventions, including escalation for suicide risk, self-harm concerns, and welfare checks when necessary. Join our Utilization Management team and help ensure members receive timely, appropriate behavioral health services while making a meaningful impact on outcomes.