- 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
- Evolent (Lansing, MI)
- …new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts as assigned mentor as ... Stay for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a...Provides medical direction to the support services review process. Responsible for the quality of utilization… more
- Evolent (Lansing, MI)
- …non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National...process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Humana (Lansing, MI)
- …how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer based review of moderately complex to complex ... management. + Utilization management experience in a medical management review organization, such as Medicare...on size of region or line of business. The Medical Director conducts Utilization Management… more
- Evolent (Lansing, MI)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent (Lansing, MI)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... **What You'll Be Doing:** As a Vascular Surgery, Field Medical Director you will be a key... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Molina Healthcare (Ann Arbor, 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
- Humana (Lansing, MI)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex ... management. + Utilization management experience in a medical management review organization, such as Medicare...on size of region or line of business. The Medical Director conducts Utilization Management… more
- Humana (Lansing, MI)
- …Medical Director , depending on size of team or line of business. The Medical Director conducts Utilization Management of the care received by members ... caring community and help us put health first** The Medical Director relies on fundamentals of CMS...management. + Utilization management experience in a medical management review organization, such as Medicare… more
- Humana (Lansing, MI)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex ... caring community and help us put health first** The Medical Director actively uses their medical...management. + Utilization management experience in a medical management review organization, such as Medicare… 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
- Evolent (Lansing, MI)
- …timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent (Lansing, MI)
- …timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... the culture. **What You'll Be Doing:** As a Field Medical Director , MSK Surgery you will be... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Elevance Health (Dearborn, MI)
- ** Medical Director - PathWays for Aging Program** Location: This role enables associates to work virtually full-time, with the exception of required in-person ... and ensures essential face-to-face onboarding and skill development. The ** Medical Director ** will have program management responsibilities including… more
- Elevance Health (Dearborn, MI)
- …and external physicians. + Applies clinical knowledge and skills to utilization review processes. + Adheres to medical policies and clinical guidelines. + As ... **Behavioral Health Medical Director - Child Psychiatrist** Location: This...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Corewell Health (Grand Rapids, MI)
- …in coordination with external partners and reports directly to the Senior Director of Utilization Management. Essential Functions Strategic Leadership & Program ... Job Summary The Director , Highly Integrated Dual Eligible Special Needs (HIDE-SNP)...Integration: + Collaborate with leaders across the enterprise (eg, Medical Directors, Quality Improvement, Utilization Management, Care… more
- Humana (Lansing, MI)
- …put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate ... Medical Director works on problems of diverse scope and complexity...focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with… more
- Evolent (Lansing, MI)
- …Stay for the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in ... improving healthcare quality.** + **Computer proficiency** and ability to navigate electronic medical review platforms. + No current exclusions, sanctions, or… more
- Highmark Health (Lansing, MI)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... and improve the care of our members **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy criteria, which may… more
- Travelers Insurance Company (Lansing, MI)
- …influences 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 ...Have?** + Licensed MD + 5 years clinical and utilization management experience + Certified by the American Board… more