- 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
- 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
- Molina Healthcare (Sterling Heights, MI)
- …Care experience **OR** 5 years experience as a Molina Medical Director + Demonstrated experience in Utilization /Quality Program management + Previous ... Supervises and manages Medical Directors + Develops medical policies and procedures + Conducts peer review... medical policies and procedures + Conducts peer review **JOB QUALIFICATIONS** **REQUIRED EDUCATION:** * Doctorate Degree in… more
- Sunrise Senior Living (West Bloomfield, MI)
- …Sunrise of West Bloomfield **Job ID** 2025-228967 **JOB OVERVIEW** The Executive Director is responsible for overall leadership, management, and success of the ... and services to seniors better than anyone. The Executive Director creates, in alignment with our mission and values,...achieving customer engagement. + Lead the development and regular review of the engagement improvement plan. + Resolve customer… more
- Renaissance (Detroit, MI)
- …strive for the best, own our actions, and grow and evolve. The Director of Compensation & Benefits is responsible for the strategic direction and leadership ... design, administration, communication, compliance, activities and vendor management. The Director will manage, plan, direct, develop, communicate and coordinate work… 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
- Novo Nordisk (Detroit, MI)
- … Director . Relationships Position reports to Field Director /Senior Field Director . Serves as organization spokesperson on advanced medical and technical ... About the Department The Clinical, Medical and Regulatory (CMR) department at Novo Nordisk...monthly reports on scientific support activities in region to Director including budget expenditures as directed + Records all… more
- Fresenius Medical Center (Romulus, MI)
- …+ Facilitates the application process for physician privileges and compliance with FMS Medical Staff By-Laws. + Responsible for strong Director and physician ... communicated to and implemented by the facility staff. + Maintains integrity of medical records and other FMS administrative and operational records. + Complies with… more
- Molina Healthcare (Sterling Heights, MI)
- …clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight ... following: + Provides medication therapy management including examination of member medical records, performing a comprehensive medication review , and… more
- Henry Ford Health System (Detroit, MI)
- GENERAL SUMMARY: Works collaboratively with the Radiology/ Medical Imaging/Diagnostic Center management team, hospital physicians, staff and outside agencies to ... budgets. Ensures the delivery of high-quality patient care through the utilization of appropriate staffing, supplies and equipment in accordance with accreditation… 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
- AECOM (Detroit, MI)
- …in order to be able to identify support personnel and facilitate the quality review process for any regional project. In the event quality issues are identified, ... and implementation of solutions with the support of the Director of Project Delivery. + Ability to mentor junior...major pursuits by actively participating in the development and review of Project Plans and incorporation of other project… 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
- 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
- Henry Ford Health System (Detroit, MI)
- GENERAL SUMMARY: Under supervision of the Director , Strategic Sourcing and in accordance with established policies and procedures, the Contract Sourcing Manager is ... for sourcing products, capital equipment and/or services. Takes into account quality, utilization , cost and other direct and indirect factors. Prepares reports on… 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
- Tenet Healthcare (Detroit, MI)
- …specific service line meetings as appropriate. 4. Collaborate with the Maternal Medical Director , neonatal program, consulting physicians and nursing leaders and ... of care inclusive of the QAPI Plan. Other oversight includes: a. utilization of telehealth/telemedicine, if used. 2. Develop and maintain the Maternal Program… more