- 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
- 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
- Sunrise Senior Living (West Bloomfield, MI)
- …a big breath of fresh air."_** **_- Sunrise Leader_** The Executive Director is responsible for overall leadership, management, and success of their community. ... & services to seniors better than anyone. The Executive Director is expected to create, in alignment with our...achieving customer engagement. + Leads the development and regular review of the engagement improvement plan. + Effectively resolves… 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
- Corewell Health (Royal Oak, MI)
- …and implementation performance evaluations, OPPE/FPPE, etc. Represents APPs to outside review services such as Joint Commission, American College of Surgeons etc. ... area of expertise or as determined by the APP Director or VP of APP Services. Note: This is...practices and monitoring metrics such as reimbursement, productivity, and utilization . + Act as central oversight for CE/CME policy… more
- Henry Ford Health System (Troy, MI)
- …contracting and operational issues with payers, including billing, claim underpayments, utilization review , credentialing, notification of site closures or new ... GENERAL SUMMARY: Reporting to the Director - Managed Care Contracting, this position is...for managing the payor contracting functions for the hospitals, medical centers, urgent care centers, and employed physicians of… 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
- McLaren Health Care (Lake Orion, MI)
- …based on medical necessity and contractual benefits. Emphasis on utilization review , documentation and transition planning. Works in coordination with ... **Position Summary:** As directed by the Executive Director , the Admissions/Discharge Coordinator manages patients through the...within 4 hours of referral being made. Conducts a medical record review and interviews referral/responsible party… more
- Behavioral Center of Michigan (Warren, MI)
- …records for discharge/transfer. Makes appropriate copies for various departments (Nursing, Utilization Review , Billing, and Partial Hospitalization Program). + ... setting. Meets the communication needs of the patient/family, departmental staff and medical staff. Prepares and compiles records for the unit. Upholds system and… more