- Integra Partners (Troy, MI)
- Position Summary + Integra Partners is seeking a full-time Utilization Review Medical Director to support our Utilization Management team. This is a ... the local delivery system rendering the criteria inappropriate, the Utilization Management Nurse will route the case to the...UR Medical Director . The UR Medical Director will review the… more
- Molina Healthcare (Warren, MI)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... + 3+ years relevant experience, including: + 2 years previous experience as a Medical Director in a clinical practice. + Current clinical knowledge. + Experience… more
- Tenet Healthcare (Detroit, MI)
- …staffing and skill mix, complex Case Management, and centralized utilization review · Participate in new hospital Director of Case Management selection ... Group Director of Case Management - 2506001359 Description :...support overall strategic plans of the Case Management and Utilization Review strategy · Lead Group hospital… more
- Elevance Health (Dearborn, MI)
- ** Medical Director - PathWays for Aging Program** Location: This role enables associates to work virtually full-time, with the exception of required in-person ... and ensures essential face-to-face onboarding and skill development. The ** Medical Director ** will have program management responsibilities including… more
- Elevance Health (Dearborn, MI)
- …and external physicians. + Applies clinical knowledge and skills to utilization review processes. + Adheres to medical policies and clinical guidelines. + As ... **Behavioral Health Medical Director - Child Psychiatrist** Location: This...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Microsoft Corporation (Detroit, MI)
- …solutions on the Microsoft Advertising platform. We are seeking an experienced ** Director of Audience Ads** to drive Microsoft Advertising revenue growth globally, ... Sales and for the evolution of contractual strategy related to these products. The Director of Audience Ads should have a proven track record of building, managing… more
- Corewell Health (Royal Oak, MI)
- …patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). 2. ... status and level of care. Uses defined resources to guide decisions, including Medical Director Care Management, Physician Advisors, and management staff. 5.… more
- Corewell Health (Troy, MI)
- …patients. + Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). + ... status and level of care. Uses defined resources to guide decisions, including Medical Director Care Management, Physician Advisors, and management staff. +… more
- Corewell Health (Royal Oak, MI)
- …and implementation performance evaluations, OPPE/FPPE, etc. Represents APPs to outside review services such as Joint Commission, American College of Surgeons etc. ... area of expertise or as determined by the APP Director or VP of APP Services. Note: This is...practices and monitoring metrics such as reimbursement, productivity, and utilization . + Act as central oversight for CE/CME policy… more
- Henry Ford Health System (Troy, MI)
- …contracting and operational issues with payers, including billing, claim underpayments, utilization review , credentialing, notification of site closures or new ... GENERAL SUMMARY: Reporting to the Director - Managed Care Contracting, this position is...for managing the payor contracting functions for the hospitals, medical centers, urgent care centers, and employed physicians of… 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...contractual provisions and rates on behalf of HFHS Hospitals, Medical Group, Behavioral Health Services and other business units.… 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
- Behavioral Center of Michigan (Warren, MI)
- …records for discharge/transfer. Makes appropriate copies for various departments (Nursing, Utilization Review , Billing, and Partial Hospitalization Program). + ... setting. Meets the communication needs of the patient/family, departmental staff and medical staff. Prepares and compiles records for the unit. Upholds system and… more
- Tenet Healthcare (Detroit, MI)
- …specific service line meetings as appropriate. 4. Collaborate with the Maternal Medical Director , neonatal program, consulting physicians and nursing leaders and ... of care inclusive of the QAPI Plan. Other oversight includes: a. utilization of telehealth/telemedicine, if used. 2. Develop and maintain the Maternal Program… more