- Molina Healthcare (Warren, MI)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Molina Healthcare (Warren, MI)
- …3+ years HMO/Managed Care experience **OR** 5 years experience as a Molina Medical Director + Demonstrated experience in Utilization/Quality Program management + ... Summary** Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and… more
- Molina Healthcare (Warren, MI)
- **JOB DESCRIPTION** **Job Summary** Responsible for analysis of Medicaid and Medicare financial reports, trend, and opportunities. Includes evaluation of and ... recommendations relating to business opportunities, Medicare bids, investments, financial regulations, and similar financial projects...early signs of trends or other issues related to medical care cost. + Design and perform actuarial studies… more
- AmeriHealth Caritas (Detroit, MI)
- …and authorizations, including home- and community-based programs. + Collaborate with the Medical Director and care team to develop and monitor treatment ... the Medicare LTSS Care Coordinator manages care coordination for Medicare beneficiaries with complex medical , behavioral health, Long-Term Services &… more
- Humana (Warren, MI)
- …of everything it does. The MarketPoint Career Channel Team is looking for skilled Medicare Field Sales Agents. This is a field-based role, and candidates must live ... community. As part of a collaborative team of 8-12 Medicare Sales Agents, you'll work under the guidance of...under the guidance of a Senior Manager and Regional Director who are committed to your success. Together, you'll… more
- R1 RCM (Detroit, MI)
- …transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise ... enhancing the patient experience. As the Government Navigation Services (GNS) Business Development Director , you will focus on engaging and targeting new Tier 1 and… more
- Henry Ford Health System (Troy, MI)
- …to meet urgent Part D and pharmacy analysis needs. This new Director role establishes dedicated, in-house pharmacy actuarial expertise to strengthen financial ... competitive advantage in 2026 and beyond. Position Summary The Director , Actuarial Services - Pharmacy / Part D is...Health Alliance Plan (HAP), with a primary focus on Medicare Part D and broader enterprise pharmacy strategy. This… more
- Molina Healthcare (Warren, MI)
- …reviews behavioral health portions of state contracts. * Assists behavioral health medical director lead trainers in the development of enterprise-wide education ... JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health...National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS). * Assists with the… more
- Molina Healthcare (Warren, 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
- Grifols Shared Services North America, Inc (Detroit, MI)
- …and services in more than 110 countries and regions. The Associate Director , Value Access Marketing & Reimbursement is responsible for developing and executing ... access customer segment . Support reimbursement, coding, and coverage-related responsibilities for Medicare Part B, Centers for Medicare and Medicaid (CMS)… more
- Henry Ford Health System (Detroit, MI)
- …the nation's premier academic and integrated health systems, is seeking a Director of Corporate Reimbursement to lead critical financial functions that directly ... thoughtful integration of reimbursement practices into systemwide financial strategies. The Director will serve as a trusted partner to executive leadership,… more
- Molina Healthcare (Warren, MI)
- …and Joint Operating Committees. * Manages and reports network adequacy for Medicare , Marketplace, and Medicaid services. * In conjunction with direct management and ... recontracting initiatives. Implements cost control initiatives to positively influence the Medical Care Ratio (MCR) in each contracted region. * Leads preparation… more
- ChenMed (Detroit, MI)
- …translates these into actions improving patient care and collaboration while reducing medical costs. The Network Representative is also the main market Network ... for operations, clinical, Referrals, Hospital and Community Care Team, Specialty and Medical Centers of Excellence, and Health Economics teams. This role works with… more
- Danaher Corporation (Detroit, MI)
- …engagement and responding to customer inquiries. This position reports to the Senior Director Market Access Americas and is part of the Value and Access team. ... + Communicate regional and local coverage and reimbursement issues for Medicare , Medicaid and Commercial payers through internal meetings, payer research, and… 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
- Henry Ford Health System (Detroit, MI)
- …specifically related to Transplant including The Joint Commission, Centers for Medicare and Medicaid Services (CMS), United Network for Organ Sharing (UNOS), ... Network. . This employee will collaborate with the Administrative Director of Transplant Institute and the Program Director...Ford is one of the nation's most respected academic medical centers and is leading the Future of Health:… more
- Integra Partners (Troy, MI)
- …policies). + Review and process clinical and administrative appeals; coordinate with Medical Director when required. + Generate and review daily/weekly reporting ... + Excellent verbal/written communication and organizational skills. + Experience with Medicare and Medicaid requirements. + Familiarity with DMEPOS authorization and… more
- Henry Ford Health System (Troy, MI)
- …processes within value-based reimbursement models and initiatives. Reporting to the Director , Risk Adjustment and Value-Based Payment, the Program Manager is ... both departmental staff and multi-disciplinary teams. + Knowledge of Medicare , Medicaid, Blue Cross and other third-party payers billing...Ford is one of the nation's most respected academic medical centers and is leading the Future of Health:… more