*Job seekers: please be aware of fraudulent job postings and phishing scams via LinkedIn. Henry Ford Health only contacts applicants through our human resources department and via a corporate email address. Here are some tips to be aware of: http://ow.ly/Kc0o50EKory Serving communities across Michigan and beyond, Henry Ford Health is committed to partnering with patients and members along their entire health journey.Henry Ford Health provides a full continuum of services – from primary and preventative care, to complex and specialty 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.The health system is led by President and CEO Bob Riney and serves a growing number of customers across 250+ locations throughout Michigan including five acute care hospitals, two destination facilities for complex cancer and orthopedics and sports medicine care, three behavioral health facilities, primary care and urgent care centers.

Job description

General Summary

Under minimal supervision, reviews and screens the appropriateness of services, the utilization of hospital resources and the quality of patient care rendered. Combines clinical, business, regulatory knowledge, and skill to reduce significant financial risk and exposure caused by concurrent and retrospective denial of payments for services provided. Through continuous assessments from admission through discharge, problem identification and education, facilitates the quality of health care delivery in the most cost effective and efficient manner. Utilizes best practice workflows, evidence-based screening criteria and critical thinking to maximize reimbursement.

Education/Experience Required

Registered Nurse required.
Minimum 3-5 years of clinical experience required.
Bachelor of Science Nursing required OR four (4) years Case Management/ Appeal/Utilization Management experience in lieu of bachelor's degree.

Certifications/Licensures Required