- Corewell Health (Grand Rapids, MI)
- …in the managed care setting. Essential Functions + Performs day to day clinical pharmacy functions including prior authorization and appeal reviews. + Uses ... related to NCQA, HEDIS, CAHPS, STAR measures, and other clinical quality and programs. Adheres to Pharmacy ...2 years of relevant experience Familiarity with the Michigan health care market and provider groups and practices About… more
- Molina Healthcare (Grand Rapids, MI)
- …program experience as needed (such as specialties in: surgical, ob/gyn, home health , pharmacy , etc.), or equivalent combination of relevant education and ... Office suite/applicable software program(s) proficiency. **Preferred Qualifications** * Certified Clinical Coder (CCC), Certified Medical Audit Specialist … more
- Molina Healthcare (Grand Rapids, MI)
- …benefits, and medical records to document relevant findings of a post pay clinical review. This position manages documents and prioritizes case load to ensure timely ... + Review of applicable policies, CPT guidelines, and provider contracts. + Devise clinical summary post review. + Communicate and participate in meetings related to… more