- Conifer Revenue Cycle Solutions (Detroit, MI)
- …process quality and accuracy adherence to process standards Relative cost management metrics goals expense, cost, and margin control monthly, quarterly, and ... annual financial goal management ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others...of hospital budgets and ensures and manages human resource utilization at all levels. Analyzes monthly P planning, assigning… more
- Henry Ford Health System (Clinton Township, MI)
- GENERAL SUMMARY: The Medical Director of Utilization Management shall have responsibility for the medical oversight of activities related to Henry ... REQUIRED: MD or DO. Two (2) years of physician advisor and/or utilization management experience. Medical Staff membership in good standing at Henry… more
- Molina Healthcare (Sterling Heights, MI)
- …as a Molina Medical Director + Demonstrated experience in Utilization /Quality Program management + Previous leadership experience + Peer review, ... Summary** Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and… 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 authorization sand appeals. JOB...with authorization requests + Contact requesting providers to obtain medical records or other necessary documentation related to specific… more
- Molina Healthcare (Sterling Heights, MI)
- …, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk ... resource management . + Develops and implements a Utilization Management program and action plan, which...activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. +… more
- Molina Healthcare (Sterling Heights, MI)
- …, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk ... resource management . + Develops and implements a Utilization Management program and action plan, which...activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. +… more
- Molina Healthcare (Sterling Heights, MI)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- Molina Healthcare (Sterling Heights, MI)
- …, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk ... and chemical dependency services. Works closely with the Regional Medical Directors to standardized utilization management...**REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3… more
- Molina Healthcare (Sterling Heights, MI)
- …closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and ... and clinical leadership for health plan and/or market specific utilization management and care management ...health portions of state contracts. * Assists behavioral health medical director lead trainers in the development… more
- Gentiva (Clinton Township, MI)
- …Transform Care through Compassionate Hospice Leadership.** We are seeking a dedicated Hospice Medical Director to join our leadership team and provide expert ... substances. + Hospice and Palliative Medicine board certification and/or Hospice Medical Director Certification Board certification preferred. + Current Medicare… more
- Gentiva (Southfield, MI)
- …budgeting while driving branch revenue growth through census development, referral management , and efficient resource utilization + Maintain strong relationships ... exciting and rewarding opportunity for a RN Hospice Executive Director to join our leadership team. This role is...experience in hospice care, home health, or clinical operations management . If you're a natural leader who is passionate… more
- Henry Ford Health System (Troy, MI)
- …to meet urgent Part D and pharmacy analysis needs. This new Director role establishes dedicated, in-house pharmacy actuarial expertise to strengthen financial ... position HAP for competitive advantage in 2026 and beyond. Position Summary The Director , Actuarial Services - Pharmacy / Part D is responsible for leading all… more
- Ascension Health (West Bloomfield, MI)
- **Details** + **Department:** Supply Chain Management + **Schedule:** Full time, Days + **Hospital:** Henry Ford West Bloomfield and other surrounding Metro Detroit ... transformation services organization that specializes in resource and supply chain management . The Resource Group transforms the resource and supply function within… more
- Molina Healthcare (Sterling Heights, MI)
- …with operational management to identify saving opportunities and areas of medical utilization concerns. + Provide support to financial closing process ... early signs of trends or other issues related to medical care cost. + Design and perform actuarial studies...+ Research and develop reports and analysis for senior management , effectively presenting and communicating results. + Works closely… more
- Molina Healthcare (Sterling Heights, MI)
- …active and unrestricted in state of practice. * Deep understanding of clinical operations: utilization management , care management , etc. * Ability to provide ... of relevant education and experience. * At least 3 years health care management /leadership experience. * Registered Nurse (RN) or other advanced clinical or … more
- Molina Healthcare (Sterling Heights, MI)
- …+ Manage projects spanning multiple domains + Supports Market and Enterprise management and other team members are related to all things financially related ... reserves for appropriateness monthly + Work collaboratively with Actuarial and Medical Economics partners to evaluate correlation among various parameters impacting… more
- Corewell Health (Royal Oak, MI)
- …status and level of care. Uses defined resources to guide decisions, including Medical Director Care Management , Physician Advisors, and management ... of care and cost effectiveness through the integration and functions of utilization management , and/or care coordination, discharge planning, and appropriate… more
- Henry Ford Health System (Bingham Farms, MI)
- …patient-centered solutions. This leader will shape HAP's pharmacy benefit design, utilization management , PBM relationships, and formulary strategy to improve ... to the Chief Pharmacy Officer. This role also reports indirectly to the HAP Medical Director . PRINCIPLE DUTIES AND RESPONSIBILITIES: + Oversees all aspects of… more
- Henry Ford Health System (Troy, MI)
- …relevant contractual requirements and issues to internal customers such as Utilization Management , Finance, Patient Billing, Administration, Legal, etc. 7. ... 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
