- GCG (Rochester Hills, MI)
- …in distribution and/or manufacturing environments + Strong collaboration, change management , and leadership skills + Analytical, data -driven decision-making ... **Overview** **GCG is seeking a Human Resources Director to drive people strategies that deliver business...across multiple states, both virtually and in person, to provide strategic HR guidance + Advise the Operations and… more
- Molina Healthcare (Sterling Heights, MI)
- …design solutions utilizing provider data such as the Provider Online Directory, Utilization Management , Customer Experience, Enrollment, and Claims ... **Job Description** **Job Summary** The Network Solutions Director is responsible for leading a team designing...combination of education and experience **Required Experience** 7-9 years Provider Data **Preferred Education** Graduate Degree or… more
- Molina Healthcare (Sterling Heights, MI)
- … Information process functions. * Directs the development, implementation and maintenance of provider data in the claims payment system. * Supports critical ... databases. Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems and application of… more
- Molina Healthcare (Sterling Heights, MI)
- …optimization, and service delivery + Overseeing implementation of scalable solutions for provider onboarding, data management , and credentialing operations + ... **JOB DESCRIPTION** **Job Summary** Lead operational readiness initiatives across provider data and credentialing functions, supporting both new implementations… more
- Molina Healthcare (Sterling Heights, MI)
- …and ensure adherence to business, system and regulatory requirements of Provider Data Management /Network Adequacy. **Knowledge/Skills/Abilities** + ... work with other teams including New Markets team, Network Management , Product Teams, PDM and IT. **Job Qualifications** **REQUIRED...EXPERIENCE:** + Advanced Excel skills. + Power BI. + Provider Data Analytics. To all current Molina… more
- Molina Healthcare (Sterling Heights, MI)
- **Job Description** **Job Summary** The Director , Clinical Data Acquisition for Risk Adjustment, is responsible for the implementation, monitoring, and oversight ... and data completeness training, onboarding for CDA team members, vendor management for chart collection vendors, Supplemental data , and chart collection… more
- Molina Healthcare (Sterling Heights, MI)
- …regarding utilization practices, guideline usage, pharmacy utilization and effective resource management . + Develops and implements a Utilization Management ... activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare, Medicaid,… more
- Molina Healthcare (Sterling Heights, MI)
- …regarding utilization practices, guideline usage, pharmacy utilization and effective resource management . + Develops and implements a Utilization Management ... activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare, Medicaid,… more
- Molina Healthcare (Sterling Heights, MI)
- …of value-based care models, provider enablement strategies, and population health management . + Strong knowledge of data integration, EMR systems, and ... programs focused on provider enablement, ensuring access to tools, training, and data for success in VBC models. + Design and implement VBC training programs,… more
- Molina Healthcare (Sterling Heights, MI)
- …HMO/Managed Care experience **OR** 5 years experience as a Molina Medical Director + Demonstrated experience in Utilization/Quality Program management + Previous ... Assists in recruitment, hiring and training of staff as needed. + Analyzes data and identifies medical cost savings and quality improvement opportunities. + Accounts… more
- Molina Healthcare (Sterling Heights, MI)
- …timely maintenance of critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems when applicable, ... business rules as they apply to each database. Validate data to be housed on provider databases...Identified as contract system lead by developing and maintaining provider contracts in contract management software. *… more
- Molina Healthcare (Sterling Heights, MI)
- …compliance program, including annual, periodic, focal, etc. audits. * Performance Management & KPI Expertise: Develop, implement, and monitor KPIs, including leading ... adherence, diagnose root causes of misses, and drive accountability across functions. * Data Insight & Decision Support: Ingest and interpret complex data from… more
- Molina Healthcare (Sterling Heights, MI)
- …practice. * Deep understanding of clinical operations: utilization management , care management , etc. * Ability to provide hands-on, immersive and directed ... to establish strategic plans and objectives. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Under the… more
- Sunrise Senior Living (Troy, MI)
- …NAME** Sunrise of Troy **Job ID** 2025-226154 **JOB OVERVIEW** The Resident Care Director (RCD) serves as the nursing clinical leader for the community and is ... of all Care programs, regulatory compliance, recruiting, and performance management . **RESPONSIBILITIES & QUALIFICATIONS** **Responsibilities:** As a part of the… more
- BrightSpring Health Services (Sterling Heights, MI)
- …the little things make the biggest difference. Our mission is to provide top-tier treatment rooted in evidence-based ABA principles, celebrating everyday successes. ... thrive. We believe BCBAs should focus on delivering high-quality therapy, so we provide exceptional administrative and clinical support to make your job easier and… more
- Molina Healthcare (Sterling Heights, MI)
- **Job Description** **Job Summary** Molina Health Plan Provider Network Management and Operations jobs are responsible for network development, performance, and ... standards. + Responsible for the continued development and enhancement of the Provider Network Management and Operations Department including the implementation… more
- Sunrise Senior Living (Shelby Township, MI)
- …provides an overview of community information to those inquiries in support of the Director of Sales (DOS) and Executive Director (ED). Responsible for assisting ... Business Office Coordinator (BOC)/HR Designee in the community recruitment process, computer data entry, and other assigned general administrative duties as well as… more
- BrightSpring Health Services (Utica, MI)
- …and revises plan as indicated + Consults with Program Manager and/or Executive Director when client behaviors present potential risk management concerns and ... the little things make the biggest difference. Our mission is to provide top-tier treatment rooted in evidence-based ABA principles, celebrating everyday successes.… more
- NS International, Ltd. (Troy, MI)
- … Director of Finance, Business Planning, and Business Quality Management . Major Duties/Responsibilities + Budget / Business Planning: Facilitate/lead in the ... Director of Finance, Business Planning, and Business Quality Management . + Costing and Transfer Price Management :...the accuracy of actual program-level cost tracking. Generate and provide costing data as required by NSHQ.… more
- Molina Healthcare (Sterling Heights, MI)
- …our innovative Risk Adjustment department to assist our diverse team of data leaders, risk adjustment experts, and developers in the development and implementation ... of business strategies, operations and vendor management related to in-home assessment activities in all government...by acting as a key business partner to the Director , Prospective Programs, Market & Segment Leaders, health plan… more
