- Molina Healthcare (Detroit, MI)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Molina Healthcare (Detroit, MI)
- …3+ years HMO/Managed Care experience **OR** 5 years experience as a Molina Medical Director + Demonstrated experience in Utilization/Quality Program management + ... Summary** Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and… more
- Molina Healthcare (Detroit, MI)
- JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting ... and cost-effective member care. Essential Job Duties * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports… more
- Gentiva (Monroe, MI)
- …Hospice and Palliative Medicine board certification and/or Hospice Medical Director Certification Board certification preferred. + Current Medicare Provider ... Transform Care through Compassionate Hospice Leadership.** We are seeking a dedicated Hospice Medical Director to join our leadership team and provide expert… more
- Molina Healthcare (Detroit, MI)
- **JOB DESCRIPTION** **Job Summary** Responsible for analysis of Medicaid and Medicare financial reports, trend, and opportunities. Includes evaluation of and ... recommendations relating to business opportunities, Medicare bids, investments, financial regulations, and similar financial projects...early signs of trends or other issues related to medical care cost. + Design and perform actuarial studies… more
- AmeriHealth Caritas (Detroit, MI)
- …and authorizations, including home- and community-based programs. + Collaborate with the Medical Director and care team to develop and monitor treatment ... the Medicare LTSS Care Coordinator manages care coordination for Medicare beneficiaries with complex medical , behavioral health, Long-Term Services &… more
- Humana (Detroit, MI)
- …of everything it does. The MarketPoint Career Channel Team is looking for skilled Medicare Field Sales Agents. This is a field-based role, and candidates must live ... community. As part of a collaborative team of 8-12 Medicare Sales Agents, you'll work under the guidance of...under the guidance of a Senior Manager and Regional Director who are committed to your success. Together, you'll… more
- Molina Healthcare (Detroit, MI)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Molina Healthcare (Detroit, MI)
- …Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... (TX) Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer Review, medical policy/procedure development, provider… more
- R1 RCM (Detroit, MI)
- …transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise ... enhancing the patient experience. As the Government Navigation Services (GNS) Business Development Director , you will focus on engaging and targeting new Tier 1 and… more
- Molina Healthcare (Detroit, MI)
- …reviews behavioral health portions of state contracts. * Assists behavioral health medical director lead trainers in the development of enterprise-wide education ... JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health...National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS). * Assists with the… more
- Grifols Shared Services North America, Inc (Detroit, MI)
- …and services in more than 110 countries and regions. The Associate Director , Value Access Marketing & Reimbursement is responsible for developing and executing ... access customer segment . Support reimbursement, coding, and coverage-related responsibilities for Medicare Part B, Centers for Medicare and Medicaid (CMS)… more
- Henry Ford Health System (Detroit, MI)
- …the nation's premier academic and integrated health systems, is seeking a Director of Corporate Reimbursement to lead critical financial functions that directly ... thoughtful integration of reimbursement practices into systemwide financial strategies. The Director will serve as a trusted partner to executive leadership,… more
- Molina Healthcare (Detroit, MI)
- …and Joint Operating Committees. * Manages and reports network adequacy for Medicare , Marketplace, and Medicaid services. * In conjunction with direct management and ... recontracting initiatives. Implements cost control initiatives to positively influence the Medical Care Ratio (MCR) in each contracted region. * Leads preparation… more
- Danaher Corporation (Detroit, MI)
- …engagement and responding to customer inquiries. This position reports to the Senior Director Market Access Americas and is part of the Value and Access team. ... + Communicate regional and local coverage and reimbursement issues for Medicare , Medicaid and Commercial payers through internal meetings, payer research, and… more
- Trinity Health (Livonia, MI)
- …at the time of visit or within 48 hours. + Collaborate with the Medical Director , interdisciplinary team, and leadership to ensure continuity of care. + ... home, offering skilled nursing, therapy (physical, occupational, speech) and medical social work. We are Medicare -certified and...speech) and medical social work. We are Medicare -certified and accredited by The Joint Commission. Learn more… more
- Gentiva (Monroe, MI)
- …Care Manager to join our hospice team. Reporting directly to the Executive Director or Administrator, you will oversee patient care activities to ensure the delivery ... based on clinical judgment and priority + T riage incoming phone referrals and medical concerns in a timely, compassionate, and professional manner + L ead or… more
- Elara Caring (Ypsilanti, MI)
- …at no cost + Opportunities for advancement + Comprehensive insurance plans for medical , dental, and vision benefits + 401(K) with employer match + Paid time ... compliance with all federal, state, and local regulations along with current Medicare , Medicaid, and third-party reimbursement regulations and changes. + Assures the… more
- Trinity Health (Livonia, MI)
- …as a primary level care provider under the clinical supervision of the Hospice Medical Director , making face-to-face assessments of hospice patients in a variety ... which practicing + Must have full (non-restricted) primary active medical staff membership at local Trinity Hospital, and remain...privileges + In good standing/able to participate in the Medicare & Medicaid programs + Minimum of 5 years… more
- Molina Healthcare (Detroit, MI)
- …with national quality and risk adjustment VPs, Regional Directors of Quality/Risk, Director of Value Based Programs, and local health plan resources. + Responsible ... program & contract design and implementation for marketplace, Medicaid and/or Medicare + Experience in a complex healthcare delivery environment, specifically with… more