- Elevance Health (Dearborn, MI)
- …the afternoons. Candidates must be able to work Eastern Time Zone hours. The ** Medicare Medical Director ** is responsible for the administration of physical ... ** Medical Director - Medicare (Part-time)** Location: This role enables associates to work virtually full-time, with the exception of required in-person… more
- Molina Healthcare (Sterling Heights, MI)
- **JOB DESCRIPTION** **Job Summary** The Medical Director for Specialty Medical Services & Market Performance will provide clinical expertise and support to ... quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to… more
- Molina Healthcare (Sterling Heights, MI)
- …Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... State Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer Review, medical policy/procedure development, provider… more
- Elara Caring (Bingham Farms, MI)
- …this mission. This means you have countless ways to make a difference as Branch Director . Being a part of something this great starts by carrying out our mission ... pioneer in delivering unparalleled care, we need a Branch Director with commitment and compassion. Are you one of...+ Opportunities for advancement + Comprehensive insurance plans for medical , dental, and vision benefits + 401(K) with employer… more
- Molina Healthcare (Sterling Heights, MI)
- …with the standards and requirements established by the Centers for Medicare and Medicaid **Knowledge/Skills/Abilities** * Leads, organizes, and directs the ... to members or authorized representatives in accordance with Centers for Medicare and Medicaid standards/requirements. * Provides direct oversight, monitoring and… more
- Bayer (Farmington, MI)
- …minds to make a real difference, there's only one choice.** **Associate Director , Field Reimbursement, Oncology - Great Lakes Region** **Associate Director , ... HCPs and Office staff in navigating therapy Prior Authorizations (PAs), Medical Necessity documentation and therapy PA denial appeals. Develop collaborative working… more
- Integra Partners (Troy, MI)
- …+ Be prepared to appeal or correct CRT claims in compliance with Medicare , Medicaid, and commercial insurance guidelines. + Ensure all required documentation (eg, ... prescriptions, prior authorizations, therapist evaluations, and medical necessity justifications) is included with claims. + Verify coding accuracy, including HCPCS… more
- Elara Caring (Rochester Hills, MI)
- …package + Comprehensive onboarding and mentorship + Opportunities for advancement + Medical , dental, and vision benefits, 401K match and paid time off for ... experience In a Health Care setting + Knowledge of Medicare and Medicaid, home health care benefits, policies and...perform job responsibilities You will report to the Branch Director , Alternative Branch Director , or Regional Branch… more
- Option Care Health (Farmington Hills, MI)
- …and delivering presentations within Option Care and externally with customers (ex. medical director , head of case management, executive c-suite individuals). ... oncology, or transplant. + Basic understanding of billing and reimbursement procedures for hospital, medical offices, and Medicare (B/D + benefits) as well as … more
- Henry Ford Health System (Troy, MI)
- GENERAL SUMMARY: Reporting to the Director - Managed Care Contracting, this position is responsible for managing the payor contracting functions for the hospitals, ... medical centers, urgent care centers, and employed physicians of...payor relationships including direct to employer relationships and commercial, Medicare Advantage, Medicaid HMO, and other governmental payors. 4.… more
- Trinity Health (Ypsilanti, MI)
- …area for productivity and adjust as needed. + Works closely with the medical directors and executive director to maintain a high-quality cost-effective programs ... performance, productivity, activity and budget. + Work with Executive Director of Michigan Heart to evaluates FTE needs in...assigned areas. + Implements measures to ensure compliance with Medicare , Federal Wage & Hour, OSHA and other regulations… more
- Molina Healthcare (Sterling Heights, MI)
- …knit proximity ongoing after contract. * In conjunction with Director /Manager, Provider Contracts, negotiates and analyzes, Complex Provider contracts including ... and/or language. Assists with cost control strategies that positively impact the Medical Care Ratio (MCR) within each region. * Advises Network Provider Contract… more