- 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 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
- Henry Ford Health System (Troy, MI)
- …manager to provide administrative, operational, and organizational support for the Utilization Management teams. PRINCIPLE DUTIES AND RESPONSIBILITIES: + ... authorization request review and present to the designated HAP Medical Director for approval or denial. +...and compliance with CMS and privacy policies. + Provides Utilization Management staff support and liaison support… more
- Molina Healthcare (Sterling Heights, 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
- Molina Healthcare (Sterling Heights, MI)
- …need. * Offers a positive leadership role in key segment/product medical management initiatives aimed a optimizing utilization of medical resources. * ... and at least 2 years as a medical director in managed care organization supporting utilization management /quality program management , or equivalent… more
- Molina Healthcare (Sterling Heights, 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 (Sterling Heights, 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 (Sterling Heights, 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
- Prime Healthcare (Port Huron, MI)
- …With Us! (https://careers-primehealthcare.icims.com/jobs/229153/multi-site- director -case- management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... to creating a positive and supportive work environment. Responsibilities The Regional Director of Case Management will be responsible for the operations… more
- Molina Healthcare (Sterling Heights, MI)
- …with operational management to identify saving opportunities and areas of medical utilization concerns. + Provide support to financial closing process ... early signs of trends or other issues related to medical care cost. + Design and perform actuarial studies...+ Research and develop reports and analysis for senior management , effectively presenting and communicating results. + Works closely… more
- Molina Healthcare (Sterling Heights, 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
- ChenMed (Eastpointe, MI)
- …to cardiology depending on the scope and member volume. + Assists the Medical Director , Cardiology (MDC) in managing the day-to-day clinical and business ... Health centers within the market. + Consults with the Medical Director , Cardiology to ensure compliance with...the Cardiology field + Superior clinical skills in the management of seniors with complex medical needs… more