RN Case Manager: Utilization & Payor Liaison

Detroit Medical Center; Detroit (MI); On-site; USD 75,000 - 100,000; Full time

Benefits offered by this job

Medical, dental, vision, and life ins.

401(k) with employer match

Generous PTO

Career development & continuing ed

Health savings accounts & FSAs

Employee Assistance program

Pet insurance

Job summary

Detroit Medical Center is seeking a Registered Nurse for Case Management to coordinate utilization of resources, ensure appropriate care level, and participate in payor communications. The role emphasizes collaboration with physicians, payors, and care teams to optimize patient outcomes.

Ideal candidates hold an active RN license, BSN preferred, and at least two years of acute hospital or behavioral health case management experience. ACM certification is a plus.

Qualifications

• RN case management experience in acute hospital or behavioral health settings is required.

Responsibilities

• Secure and document authorization for services from payors.
• Perform accurate medical necessity screening and timely submission for reviews.
• Collaborate with payors, physicians, and care teams.
• Manage concurrent disputes and report utilization variances.
• Maintain complete documentation in case management systems.
• Identify potentially avoidable days and ensure proper discharge planning.

Skills

Analytical ability

Interpersonal skills

Verbal/written communication

Teaching abilities

Organization

Flexibility with schedule

Computer literacy

Education

BSN preferred

RN license required

ACM preferred

Job description

Detroit Medical Center is seeking a Registered Nurse for Case Management to coordinate utilization of resources, ensure appropriate care level, and participate in payor communications. The role emphasizes collaboration with physicians, payors, and care teams to optimize patient outcomes.

Ideal candidates hold an active RN license, BSN preferred, and at least two years of acute hospital or behavioral health case management experience. ACM certification is a plus.