- 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
- Henry Ford Health System (Troy, MI)
- …request. + Develops authorization request review and present to the designated HAP Medical Director for approval or denial. + Based on decisions made by ... designated HAP Medical Director , ensures implementation and communication of...participates in assessment and development of proposals to improve utilization patterns, reduce medical costs, enhance provider… 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 authorizations and appeals. Rate of Pay:...to: + Monitor incoming faxes + Enter UM authorizations review requests in UM platform using ICD-10 and HCPCS… more
- Molina Healthcare (Sterling Heights, 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
- Molina Healthcare (Sterling Heights, MI)
- …Care experience **OR** 5 years experience as a Molina Medical Director + Demonstrated experience in Utilization /Quality Program management + Previous ... Supervises and manages Medical Directors + Develops medical policies and procedures + Conducts peer review... medical policies and procedures + Conducts peer review **JOB QUALIFICATIONS** **REQUIRED EDUCATION:** * Doctorate Degree in… more
- Corewell Health (Farmington Hills, 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
- Molina Healthcare (Sterling Heights, MI)
- …clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight ... with CMS guidelines. These staff may also be involved in providing utilization management/prior authorization services as needed. * Supervises the unit's daily… more
- Henry Ford Health System (Troy, MI)
- …as assigned by the Vice President, PNM and under the direction of a Director , PNM using a coordinated team approach, which typical includes the Director , ... HAP approved templates and furnish to legal counsel for review and approval. The SPCA will document the economic...also be tasked with leading a contract negotiation without Director involvement in negotiations for accounts of lesser dollar… 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