- Molina Healthcare (Sterling Heights, 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 (Sterling Heights, 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
- Henry Ford Health System (Troy, MI)
- …to meet urgent Part D and pharmacy analysis needs. This new Director role establishes dedicated, in-house pharmacy actuarial expertise to strengthen financial ... competitive advantage in 2026 and beyond. Position Summary The Director , Actuarial Services - Pharmacy / Part D is...Health Alliance Plan (HAP), with a primary focus on Medicare Part D and broader enterprise pharmacy strategy. This… more
- Molina Healthcare (Sterling Heights, MI)
- …activities for the state health plan. Works with direct management, senior leadership/management, Corporate, and staff to develop and implement standardized provider ... and Joint Operating Committees. * Manages and reports network adequacy for Medicare , Marketplace, and Medicaid services. * In conjunction with direct management and… more
- Henry Ford Health System (Troy, MI)
- …processes within value-based reimbursement models and initiatives. Reporting to the Director , Risk Adjustment and Value-Based Payment, the Program Manager is ... to both departmental staff and multi-disciplinary teams. + Knowledge of Medicare , Medicaid, Blue Cross and other third-party payers billing and reimbursement… more