- Tenet Healthcare (Detroit, MI)
- Group Director Utilization Review - 2506000536 Description : The Detroit Medical Center (DMC) is a nationally recognized health care system that serves ... and most diverse employers in Southeast Michigan. Summary Description SUMMARY: The Group Director , Utilization Review will perform the functions… more
- Molina Healthcare (Detroit, MI)
- …or exceeding productivity standards. Educates and interacts with network and group providers and medical managers regarding utilization practices, guideline ... **JOB DESCRIPTION** **Job Summary** The Medical Director for Specialty Medical Services & Market Performance...and effective resource management. + Develops and implements a Utilization Management program and action plan, which includes strategies… more
- Molina Healthcare (Detroit, MI)
- …or exceeding productivity standards. Educates and interacts with network and group providers and medical managers regarding utilization practices, guideline ... utilization and effective resource management. + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a… more
- Molina Healthcare (Detroit, MI)
- …Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health and chemical ... Health care management programs. **Knowledge/Skills/Abilities** Provides Psychiatric leadership for utilization management and case management programs for mental health… more
- Henry Ford Health System (Troy, MI)
- …Payors and facilitate resolution of contracting and operational issues, ie billing, utilization review , credentialing site visits, notification of site closures ... Reporting to Director or Manager, assist in the development of...provisions and rates on behalf of HFHS Hospitals, Medical Group , Behavioral Health Services and other business units. 1.… more
- Henry Ford Health System (Detroit, MI)
- …between HFHS and Payors on contracting and operational issues, ie billing, utilization review , credentialing site visits, notification of site closures or ... its business units. PRINCIPAL DUTIES AND RESPONSIBILITIES: 1. Under supervision of Director or Managed Care Contracting, works directly with Payors to negotiate… more
- Henry Ford Health System (Detroit, MI)
- …Coding + ED Coding + Anesthesia Coding + Clinical Documentation Improvement + Utilization Management + Clinical Denial Recovery Unit + Payer Audit + Transcription ... processes. + Use of Artificial Intelligence and Machine Learning to segment review , querying and educational activities in areas most critical to performance areas.… more