- Tenet Healthcare (Detroit, MI)
- Group Director Utilization Review - 2506000536 Description : The Detroit Medical Center (DMC) is a nationally recognized health care system that serves ... and most diverse employers in Southeast Michigan. Summary Description SUMMARY: The Group Director , Utilization Review will perform the functions… more
- Molina Healthcare (Warren, MI)
- …or exceeding productivity standards. Educates and interacts with network and group providers and medical managers regarding utilization practices, guideline ... **JOB DESCRIPTION** **Job Summary** The Medical Director for Specialty Medical Services & Market Performance...and effective resource management. + Develops and implements a Utilization Management program and action plan, which includes strategies… more
- Molina Healthcare (Grand Rapids, MI)
- …or exceeding productivity standards. Educates and interacts with network and group providers and medical managers regarding utilization practices, guideline ... utilization and effective resource management. + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a… more
- Humana (Lansing, MI)
- …insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization, ... operationalize this knowledge in their daily work. The Medical Director 's work includes computer based review of...size of region or line of business. The Medical Director conducts Utilization Management of the care… more
- Humana (Lansing, MI)
- …insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization, ... operationalize this knowledge in their daily work. The Medical Director 's work includes computer based review of...size of region or line of business. The Medical Director conducts Utilization Management of the care… more
- Humana (Lansing, MI)
- …insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization, ... Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an… more
- Molina Healthcare (Detroit, MI)
- …Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health and chemical ... Health care management programs. **Knowledge/Skills/Abilities** Provides Psychiatric leadership for utilization management and case management programs for mental health… more
- Travelers Insurance Company (Lansing, MI)
- …which can impact claim outcomes. Organize and coordinate Travelers' medical review functions. This includes interpreting Federal and State regulations and medical ... guidelines to establish medical review policies. Works in close collaboration with the Claim...industry research and analysis related to medical, healthcare and group health trends and practices to keep Travelers at… more
- Veterans Affairs, Veterans Health Administration (Iron Mountain, MI)
- …Collaborates with other facility leaders to function as a key participant in the Director and Chief of Staffs top advisory group . Maintains a collaborative ... review , provides written recommendation to the Medical Center Director pertaining to Veteran clinical appeal requests, ensuring completion. Ensures compliance… more
- University of Michigan (Ann Arbor, MI)
- …and expense projections; establish controls to maintain budget oversight; review business transactions for compliance with relevant policies and regulations ... for professional development; approve job descriptions for non-academic positions; review positions for appropriate classification and compensation level; provide… 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...provisions and rates on behalf of HFHS Hospitals, Medical Group , Behavioral Health Services and other business units. 1.… 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
- University of Michigan (Ann Arbor, MI)
- …MVC provides hospital and physician organization leaders with claims-based healthcare utilization data to empower local quality improvement activities. In addition ... providers. In this position, you will work with a highly collaborative group of clinicians, economists, health services researchers, and analysts. This position is… more
- Henry Ford Health System (Detroit, MI)
- …Coding + ED Coding + Anesthesia Coding + Clinical Documentation Improvement + Utilization Management + Clinical Denial Recovery Unit + Payer Audit + Transcription ... processes. + Use of Artificial Intelligence and Machine Learning to segment review , querying and educational activities in areas most critical to performance areas.… more