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care manager (rn)

clinical appeals nurse

medical review nurse analyst Jobs in Michigan

medical review nurse analyst

nurse

nurse practitioner

case management nurse

LanceSoft, Inc.

<div>
 
 
 Job Responsibilities:
 
 
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 The Care Manager RN leads the coordination of a multidisciplinary team to deliver a holistic, person centric care management program to a diverse health plan population with a variety of health and social needs.
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 They serve as the single point of contact for members, caregivers, and providers using a variety of communication channels including phone calls, emails, text messages and the online messaging platform.
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 The Care Manager RN uses the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the members health across the care continuum.
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 They work in partnership with the member, providers of care and community resources to develop and implement the plan of care and achieve stated goals.
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 </ul>
 
 
 
 
 
 Education and Experience:
 
 
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 Nursing Diploma or Associates degree in nursing required.
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 Bachelor&rsquo;s degree in nursing strongly preferred.
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 3 years of clinical nursing experience in a clinical, acute/post-acute care, and community setting required.
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 1 year of case management experience in a managed care setting strongly preferred.
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 Experience managing patients telephonically and via digital channels (mobile applications and messaging) preferred.
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 Current, active, and unrestricted Michigan Registered Nurse license required
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 Certification in Case Management (CCM) required or to be obtained within 18 months of hire
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 Certification in Chronic Care Professional (CCP) preferred
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 </ul>
</div>

Case Management Nurse

Strategic Staffing Solutions

<div>
 
 
 
 Medicare Advantage RN Review Analyst
 
 
 
 
 
 Location:
 
 Detroit, MI
 
 (Remote however must be local to Michigan)
 
 
 
 
 Duration:
 
 12+ Months with opportunity for FTE
 
 
 
 Role Type:
 
 W2 Contract role
 
 
 
 Max Pay Rate:
 
 $36/HR
 
 
 
 Schedule:
 
 Monday - Friday 9-5
 
 
 
 
 
 
 SUMMARY
 
 
 
 Responsible for the approval or rejection of claims and/or benefit interpretation. May be required to enter or reference data via PC and/or Clinical Review Team terminal.
 
 
 
 
 
 
 REQUIREMENTS
 
 
 <ul>
 <li>
 Registered Nurse with current Michigan Registered Nurse License.
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 Associate degree or nursing diploma required, bachelor&rsquo;s degree preferred.
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 Two (2) years RN patient care experience.
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 Triage, case management and/or rehabilitation experience preferred.
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 Medicare Advantage Part B experience a plus.
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 Expertise in the use of medical terminology.
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 Finely honed critical thinking skills are a must.
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 Knowledge of CPT/HCPCS coding and Medicare regulations desirable.
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 </ul>
 
 
 
 
 
 CERTIFICATES, LICENSES, REGISTRATIONS
 
 
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 Current unrestricted state of Michigan registered nurse license required.
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 </ul>
</div>

Medicare Advantage RN Review Analyst

DataAnnotation

<div>
 We are looking for a
 
 Clinical Appeals Nurse
 
 to join our team to train AI models. You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of each model.
 
 
 In this role, you will need to be an expert in healthcare. We are interested in a wide range of expertise, so relevant backgrounds include Clinical Documentation &amp; HIM, Medication Management (PharmD), Laboratory Medicine and Pathology Services (MLS, MD), Quality Improvement &amp; Patient Safety, Regulatory Compliance, Accreditation &amp; Medical Staff, Care Coordination &amp; Case Management, Population Health &amp; Value-Based Care, and Managed Care &amp; Utilization Management.
 
 
 
 Benefits
 
 
 
 <ul>
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 Full-time or part-time remote position
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 Choose which projects you want to work on
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 Flexible schedule
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 Projects are paid hourly starting at $50+ per hour
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 Bonuses available for high-quality and high-volume work
 
 
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 </ul>
 
 Responsibilities
 
 
 
 <ul>
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 Provide AI chatbots with diverse and complex healthcare-related problems
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 Evaluate AI outputs for logic, accuracy, and performance
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 Ensure the medical accuracy and overall quality of model responses
 
 
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 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Fluency in English (native or bilingual level)
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 <li>
 A current or in-progress medical or healthcare-related degree
 
 
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 </ul>
 
 Notes:
 
 Payment is made via PayPal. We will never ask you for any money. PayPal will handle any currency conversions from USD. Only applicants in the United States will be considered for this role. This is an independent contractor position.
 
 
 
 #medicine
 
</div>

Clinical Appeals Nurse

<div>
 We are looking for a Nurse to join our team to train AI models. You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of each model.
 
 
 
 Physicians &amp; Advanced Practice Clinicians
 
 
 
 In this role you will need to be an expert in healthcare. We are interested in a wide range of expertise, so relevant backgrounds include:
 
 
 Physicians of all specialties (e.g., Internists, Cardiologists, Oncologists), Physician Assistants, Nurse Practitioners, Certified Nurse-Midwives, Certified Registered Nurse Anesthetists, Clinical Nurse Specialists, Registered Nurses.
 
 
 
 Therapists
 
 
 
 Physical Therapists, Occupational Therapists, Speech-Language Pathologists, Respiratory Therapists, Athletic Trainers, Massage/Recreational Therapists.
 
 
 
 Diagnostic &amp; Laboratory Professionals
 
 
 
 Radiologic Technologists, Sonographers, MRI &amp; Nuclear Medicine Technologists, Medical Laboratory Scientists, Phlebotomists, Histology &amp; Genetics Technicians.
 
 
 
 Public Health &amp; Specialized Roles
 
 
 
 Dietitians/Nutritionists, Genetic Counselors, Epidemiologists, Public Health Nurses.
 
 
 
 Benefits
 
 
 
 <ul>
 <li>
 This is a full-time or part-time REMOTE position
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 You&rsquo;ll be able to choose which projects you want to work on
 </li>
 <li>
 You can work on your own schedule
 </li>
 <li>
 Projects are paid hourly starting at $50-$60 USD per hour, with bonuses on high-quality and high-volume work
 
 
 </li>
 </ul>
 
 Responsibilities
 
 
 
 <ul>
 <li>
 Give AI chatbots diverse and complex healthcare related problems and evaluate their outputs
 </li>
 <li>
 Evaluate the quality produced by AI models for correctness and performance
 </li>
 <li>
 Ensure the medical accuracy of model performance
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Fluency in English (native or bilingual level)
 </li>
 <li>
 A current or in progress medical degree
 
 
 </li>
 </ul>
 Notes: Payment is made via PayPal. We will never ask for any money from you. PayPal will handle any currency conversions from USD. Only applicants in the United States will be considered for this role. This is an independent contract position.
 
 
 #medicine
</div>

Nurse

<div>
 We are looking for a Nurse Practitioner to join our team to train AI models. You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of each model.
 
 
 
 Physicians &amp; Advanced Practice Clinicians
 
 
 
 In this role you will need to be an expert in healthcare. We are interested in a wide range of expertise, so relevant backgrounds include:
 
 
 Physicians of all specialties (e.g., Internists, Cardiologists, Oncologists), Physician Assistants, Nurse Practitioners, Certified Nurse-Midwives, Certified Registered Nurse Anesthetists, Clinical Nurse Specialists, Registered Nurses.
 
 
 
 Therapists
 
 
 
 Physical Therapists, Occupational Therapists, Speech-Language Pathologists, Respiratory Therapists, Athletic Trainers, Massage/Recreational Therapists.
 
 
 
 Diagnostic &amp; Laboratory Professionals
 
 
 
 Radiologic Technologists, Sonographers, MRI &amp; Nuclear Medicine Technologists, Medical Laboratory Scientists, Phlebotomists, Histology &amp; Genetics Technicians.
 
 
 
 Public Health &amp; Specialized Roles
 
 
 
 Dietitians/Nutritionists, Genetic Counselors, Epidemiologists, Public Health Nurses.
 
 
 
 Benefits
 
 
 
 <ul>
 <li>
 This is a full-time or part-time REMOTE position
 </li>
 <li>
 You&rsquo;ll be able to choose which projects you want to work on
 </li>
 <li>
 You can work on your own schedule
 </li>
 <li>
 Projects are paid hourly starting at $50-$60 USD per hour, with bonuses on high-quality and high-volume work
 
 
 </li>
 </ul>
 
 Responsibilities
 
 
 
 <ul>
 <li>
 Give AI chatbots diverse and complex healthcare related problems and evaluate their outputs
 </li>
 <li>
 Evaluate the quality produced by AI models for correctness and performance
 </li>
 <li>
 Ensure the medical accuracy of model performance
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Fluency in English (native or bilingual level)
 </li>
 <li>
 A current or in progress medical degree
 
 
 </li>
 </ul>
 Notes: Payment is made via PayPal. We will never ask for any money from you. PayPal will handle any currency conversions from USD. Only applicants in the United States will be considered for this role. This is an independent contract position.
 
 
 #medicine
</div>

Nurse Practitioner

<div>
 We are looking for a Pharmacy Technician to join our team to train AI models. You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of each model.
 
 
 
 Physicians &amp; Advanced Practice Clinicians
 
 
 
 In this role you will need to be an expert in healthcare. We are interested in a wide range of expertise, so relevant backgrounds include:
 
 
 Physicians of all specialties (e.g., Internists, Cardiologists, Oncologists), Physician Assistants, Nurse Practitioners, Certified Nurse-Midwives, Certified Registered Nurse Anesthetists, Clinical Nurse Specialists, Registered Nurses.
 
 
 
 Therapists
 
 
 
 Physical Therapists, Occupational Therapists, Speech-Language Pathologists, Respiratory Therapists, Athletic Trainers, Massage/Recreational Therapists.
 
 
 
 Diagnostic &amp; Laboratory Professionals
 
 
 
 Radiologic Technologists, Sonographers, MRI &amp; Nuclear Medicine Technologists, Medical Laboratory Scientists, Phlebotomists, Histology &amp; Genetics Technicians.
 
 
 
 Public Health &amp; Specialized Roles
 
 
 
 Dietitians/Nutritionists, Genetic Counselors, Epidemiologists, Public Health Nurses.
 
 
 
 Benefits
 
 
 
 <ul>
 <li>
 This is a full-time or part-time REMOTE position
 </li>
 <li>
 You&rsquo;ll be able to choose which projects you want to work on
 </li>
 <li>
 You can work on your own schedule
 </li>
 <li>
 Projects are paid hourly starting at $50-$60 USD per hour, with bonuses on high-quality and high-volume work
 
 
 </li>
 </ul>
 
 Responsibilities
 
 
 
 <ul>
 <li>
 Give AI chatbots diverse and complex healthcare related problems and evaluate their outputs
 </li>
 <li>
 Evaluate the quality produced by AI models for correctness and performance
 </li>
 <li>
 Ensure the medical accuracy of model performance
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Fluency in English (native or bilingual level)
 </li>
 <li>
 A current or in progress medical degree
 
 
 </li>
 </ul>
 Notes: Payment is made via PayPal. We will never ask for any money from you. PayPal will handle any currency conversions from USD. Only applicants in the United States will be considered for this role. This is an independent contract position.
 
 
 #medicine
</div>

Pharmacy Technician

Meridian

<div>
 You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you&rsquo;ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 
 
 
 This is a hybrid position open to candidates residing in Wayne or Macomb County, Michigan. The role requires approximately 50% travel to member homes within these counties.
 
 
 
 
 Position Purpose
 
 Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families.
 
 
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 Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome
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 Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs
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 Identifies problems/barriers to care and provide appropriate care management interventions
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 Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services
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 Provides ongoing follow up and monitoring of member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs
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 Provides resource support to members and care managers for local resources for various services (e.g., employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans, as appropriate
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 Facilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services
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 May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources
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 Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
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 Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits
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 Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner
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 Other duties or responsibilities as assigned by people leader to meet business needs
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 Performs other duties as assigned.
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 Complies with all policies and standards.
 
 
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 </ul>
 
 Education/Experience
 
 Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing and 2 &ndash; 4 years of related experience.
 
 
 
 License/Certification
 
 
 
 <ul>
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 RN - Registered Nurse - State Licensure and/or Compact State Licensure required
 
 
 </li>
 </ul>
 Pay Range $56,200.00 - $101,000.00 per year
 
 
 Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
 
 
 Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. 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 other characteristic protected by applicable law.
 
 
 Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
</div>

Care Manager (RN)

Explore 10+ Case management nurse in Michigan this May. Find roles across top companies and apply now to boost your career.