- Molina Healthcare (Ann Arbor, MI)
- …compliance by owning Molina's entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM Oversight & Resolution you set the standards and ... related field (advanced degree a plus). **Experience** * 7+ years managing Medicare CTM, appeals & grievances, or related compliance functions-hands-on with CMS CTM… more
- Molina Healthcare (Sterling Heights, MI)
- …to members or authorized representatives in accordance with Centers for Medicare and Medicaid standards/requirements. * Provides direct oversight , monitoring ... and implements process improvements to achieve member/provider satisfaction or operational effectiveness/efficiencies which contribute to Molina Medicare 's… more
- Molina Healthcare (Grand Rapids, MI)
- …and implements process improvements to achieve member/provider satisfaction or operational effectiveness/efficiencies which contribute to Molina Medicare 's ... for leading, organizing and directing the activities of the Medicare Duals Grievance and Appeals Unit that is responsible...DSNP, HIDE, FIDE, EAE, AIP, etc. * Provides direct oversight , monitoring and training of provider disputes and appeals… more
- Corewell Health (Grand Rapids, MI)
- …Supports (LTSS) is a senior leadership role responsible for the strategic and operational oversight of long-term services and supports across the organization. ... Job Summary The Director , Highly Integrated Dual Eligible Special Needs (HIDE-SNP)...of Utilization Management. Essential Functions Strategic Leadership & Program Oversight : + Develop and implement operational plans… more
- CenterWell (Lansing, MI)
- …and communicate remediation plan to IPA Dyad partners. + Partners with market operational leaders to identify operational issues that impact clinician and coder ... staff workload and redistribute resources as needed to meet market operational demands. + Monitor coding processes, identify inefficiency, and develop… more
- CenterWell (Lansing, MI)
- …Director , the Senior Strategy Advancement Professional will bring a combination of operational support, analyst skills, and strategy oversight to the role. ... (ACO) business. This role will be responsible for supporting the CenterWell ACO and Medicare payment model programs via the Center for Medicare and Medicaid… more
- Molina Healthcare (Sterling Heights, MI)
- …in collaboration with the Manager or Director . * Keeps Manager or Director apprised of operational issues, including staffing resources, program and system ... drug regimen review, patient education, and medical staff interaction), and oversight (establishing and measuring performance metrics with regard to patient… more
- Corewell Health (Grand Rapids, MI)
- …and resolving health insurance fraud, waste, and abuse (FWA). This role provides operational oversight to the SIU team, ensuring the effective execution of ... and FWA training initiatives. The SIU Manager collaborates closely with the Director to establish program priorities, set strategic goals, and align departmental… more
- Molina Healthcare (Sterling Heights, MI)
- …strategy and development with respect to adequacy, financial performance and operational performance, in alignment with Molina Healthcare's overall mission, core ... contracts. Issue escalations, network adequacy, Joint Operating Committees, and delegation oversight . Tighter knit proximity ongoing after contract. * In conjunction… more
- Henry Ford Health System (Troy, MI)
- …group tasked with implementing system-wide improvements within multi-disciplinary operational teams, ensuring optimal and compliant Mid-Revenue Cycle processes ... within value-based reimbursement models and initiatives. Reporting to the Director , Risk Adjustment and Value-Based Payment, the Program Manager is responsible for… more