- Robert Half Legal (Farmington Hills, MI)
- …A prominent Michigan-based organization in the insurance sector is looking for a dynamic Claims Director . This position is ideal for an experienced leader with ... expertise in claims management, litigation oversight, and operational strategy. *This is...to ensure accuracy and compliance. + Support the executive director and collaborate with leadership on organizational strategy and… more
- Molina Healthcare (Sterling Heights, MI)
- **Job Description** **Job Summary** The Network Solutions Director is responsible for leading a team designing and executing new solutions. The position requires the ... lead a diverse team of technical experts and business analysts. The Solutions Director will interface with IT and business leaders to enable enterprise wide… more
- Tenet Healthcare (Commerce Township, MI)
- Director of Revenue Analysis - 2506003876 Description : Are you a results-driven leader ready to make a meaningful impact to patients, caregivers, and your ... by location and is determined by employment status Summary Job Description The Director of Revenue Analysis reports to the hospital Chief Financial Officer and… more
- Molina Healthcare (Sterling Heights, MI)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims ... the development, implementation and maintenance of provider data in the claims payment system. * Supports critical business strategies by providing systematic… more
- Molina Healthcare (Sterling Heights, MI)
- …activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare, Medicaid, ... focused reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care.… more
- Molina Healthcare (Sterling Heights, MI)
- …focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. ... * Attends or chairs committees as required such as credentialing, Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring… more
- Corewell Health (Southfield, MI)
- …activities such as personnel file requests, subpoena responses, unemployment claims processing, internet usage reporting, internal review processes, exit interviews, ... team member qualifications including health requirements, regulatory audits, team member investigations, verifications of employment, etc. + From time to time, performs investigations at the direction of legal counsel and works with legal counsel in the course… more