- Henry Ford Health System (Clinton Township, MI)
- GENERAL SUMMARY: The Medical Director of Utilization Management shall have responsibility for the medical oversight of activities related to Henry ... REQUIRED: MD or DO. Two (2) years of physician advisor and/or utilization management experience. Medical Staff membership in good standing at Henry… more
- Integra Partners (Troy, MI)
- The Utilization Management (UM) Nurse Supervisor is responsible for providing direct leadership and oversight to the UM nursing team. This role ensures team ... policies). + Review and process clinical and administrative appeals; coordinate with Medical Director when required. + Generate and review daily/weekly reporting… more
- Integra Partners (Troy, MI)
- …appeals for DMEPOS. This individual will play a key role in collaborating with our Medical Director to perform benefit and medical necessity reviews and ... medical necessity criteria + Refer cases to the Medical Director that do not meet ...we help deliver better health outcomes and more efficient management of complex healthcare benefits. Integra Partners is a… more
- Integra Partners (Troy, MI)
- The UM Coordinator assists and supports the clinical team (UM Nurses/ Medical Director ) with administrative and non-clinical tasks related to processing ... Utilization Management prior authorization sand appeals. JOB...with authorization requests + Contact requesting providers to obtain medical records or other necessary documentation related to specific… more
- Molina Healthcare (Warren, MI)
- …, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk ... resource management . + Develops and implements a Utilization Management program and action plan, which...activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. +… more
- Sevita (Detroit, MI)
- …for infants, children, adolescents, Military Service Members and Veterans. **Operations Management Executive Director - State of MI** **Compensation: ... a team-based workplace that puts people first. As Executive Director of Operations Management , you will be...increase census, maintain occupancy, improve daily attendance, and maximize utilization . + Financial Management : + Oversee billing… more
- Molina Healthcare (Warren, MI)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- Molina Healthcare (Warren, MI)
- …, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk ... and chemical dependency services. Works closely with the Regional Medical Directors to standardized utilization management...**REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3… more
- Molina Healthcare (Warren, MI)
- …closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and ... and clinical leadership for health plan and/or market specific utilization management and care management ...health portions of state contracts. * Assists behavioral health medical director lead trainers in the development… more
- Gentiva (Clinton Township, MI)
- …Transform Care through Compassionate Hospice Leadership.** We are seeking a dedicated Hospice Medical Director to join our leadership team and provide expert ... substances. + Hospice and Palliative Medicine board certification and/or Hospice Medical Director Certification Board certification preferred. + Current Medicare… more
- TEKsystems (Detroit, MI)
- TEKsystems is currently hiring for a Patient Access Director for a large hospital in Detroit, MI! **Please only apply if you have a Bachelor's degree, 4+ years of ... Director experience, and 2 years of experience managing multi-level...and accuracy - Adherence to process standards -Relative cost management metrics goals - Expense, cost, and margin control… more
- Ford Motor Company (Dearborn, MI)
- …best. **In this position ** We are seeking an experienced and strategic Director , Health Care Benefits to lead the design, evolution, and administration of Ford's ... and employer of choice. + Analyze workforce demographics, health data, and utilization patterns to design benefit strategies that optimize health outcomes, employee… more
- Tenet Healthcare (Detroit, MI)
- Clinical Quality Improvement Director - 2506003005 Description : DMC Sinai-Grace Hospital is DMC's largest hospital, offering a comprehensive heart center, cancer ... and in conjunction with the DMC Chief Quality and Medical Safety Officer, provides leadership for the development and...including at least one year of experience in the utilization of continuous improvement statistical methods and tools. 3.… more
- Molina Healthcare (Warren, MI)
- …+ Manage projects spanning multiple domains + Supports Market and Enterprise management and other team members are related to all things financially related ... reserves for appropriateness monthly + Work collaboratively with Actuarial and Medical Economics partners to evaluate correlation among various parameters impacting… more
- Corewell Health (Grosse Pointe, MI)
- …status and level of care. Uses defined resources to guide decisions, including Medical Director Care Management , Physician Advisors, and management ... of care and cost effectiveness through the integration and functions of utilization management , and/or care coordination, discharge planning, and appropriate… more
- Select Medical (Mount Clemens, MI)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... well by doing what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning, treatment plan management… more
- Henry Ford Health System (Bingham Farms, MI)
- …patient-centered solutions. This leader will shape HAP's pharmacy benefit design, utilization management , PBM relationships, and formulary strategy to improve ... to the Chief Pharmacy Officer. This role also reports indirectly to the HAP Medical Director . PRINCIPLE DUTIES AND RESPONSIBILITIES: + Oversees all aspects of… more
- AmeriHealth Caritas (Southfield, MI)
- …leadership in medical management is required. Prior experience as a Medical Director or Chief Medical Officer within a managed care organization ... + Lead strategic direction and oversight of clinical programs, including care management , utilization management , and value-based care. + Play… more
- Henry Ford Health System (Detroit, MI)
- …Elijah McCoy Campus, Centralized Pharmacy Service Center The Pharmacy Manager reports to Director of Pharmacy and works closely with the managers and staff in other ... and guidelines related to pharmaceutical coding, billing, pricing, charging, denial management , and collections. Ensure compliance with state, federal, and payer… more
- Abbott (Detroit, MI)
- …This includes influencing stakeholders within the hospital, driving product utilization , support on contracting, relationship development, relationship management ... spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 114,000 colleagues… more