- 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
- 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
- YesCare Corp (Port Huron, MI)
- …Veterans._ _\#LI-DT1_ **Responsibilities** Below is a list of your responsibilities as a **Site** ** Medical Director at St. Calir County in Port Huron, MI. Only ... need for non-formulary medication on non-formulary request form for Medical Director 's approval when non-formulary medication is...event review + Actively participant of the Utilization Review process and follow proper procedures.… more
- Molina Healthcare (Warren, 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
- Comerica (Detroit, MI)
- Job Description Senior Director , Divisional Business Risk and Control Officer The Senior Director , Divisional Business Risk and Control Officer (BRCO) is a ... are integral to reducing risk and safeguarding our customers and colleagues. The Senior Director , Divisional BRCO leads a team who are critical to the success of the… more
- Renaissance (Detroit, MI)
- …strive for the best, own our actions, and grow and evolve. The Director of Compensation & Benefits is responsible for the strategic direction and leadership ... design, administration, communication, compliance, activities and vendor management. The Director will manage, plan, direct, develop, communicate and coordinate work… 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
- Fresenius Medical Center (Romulus, MI)
- …+ Facilitates the application process for physician privileges and compliance with FMS Medical Staff By-Laws. + Responsible for strong Director and physician ... communicated to and implemented by the facility staff. + Maintains integrity of medical records and other FMS administrative and operational records. + Complies with… more
- Henry Ford Health System (Detroit, MI)
- GENERAL SUMMARY: Works collaboratively with the Radiology/ Medical Imaging/Diagnostic Center management team, hospital physicians, staff and outside agencies to ... budgets. Ensures the delivery of high-quality patient care through the utilization of appropriate staffing, supplies and equipment in accordance with accreditation… 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
- AECOM (Detroit, MI)
- …in order to be able to identify support personnel and facilitate the quality review process for any regional project. In the event quality issues are identified, ... and implementation of solutions with the support of the Director of Project Delivery. + Ability to mentor junior...major pursuits by actively participating in the development and review of Project Plans and incorporation of other project… 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
- YesCare Corp (Port Huron, MI)
- …to validate need for non-formulary medication on non-formulary request form for Medical Director 's approval when non-formulary medication is ordered. + Utilizes ... assistants or nurse practitioners as required. + Notifies Regional Medical Director and Site Health Services Administrator...event review . + Actively participant of the Utilization Review process and follow proper procedures.… 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
- McLaren Health Care (Port Huron, MI)
- …+ Responsible for the total nursing care of residents as directed by the Medical Director , attending physician, Director of Nursing and designated ... **Position Summary:** The Registered Nurse delivers quality nursing care through the utilization of the nursing process. Works collaboratively with other members of… more
- McLaren Health Care (Port Huron, MI)
- …* Responsible for the total nursing care of residents as directed by the Medical Director , attending physician, Director of Nursing and designated ... Summary:** The License Practical Nurse delivers quality nursing care through the utilization of the nursing process. Works collaboratively with other members of the… more