- Integra Partners (Troy, MI)
- …and representing Integra's clinical position to internal and external stakeholders. The Senior Utilization Review Medical Director's responsibilities ... require. The Senior MD provides clinical oversight to the Utilization Review Medical Director(s), ensures consistent application of criteria, leads … more
- Molina Healthcare (Sterling Heights, MI)
- …(RFPs). + Contributes to the development and implementation of behavioral health medical policies, peer review processes, provider education, and contract ... as a medical director in a managed care setting supporting utilization management and quality initiatives. + At least 3 years management/leadership experience. +… more
- Molina Healthcare (Sterling Heights, MI)
- …healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare ... utilization and cost containment reports and makes recommendations based...ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce report writing… more
- Molina Healthcare (Sterling Heights, MI)
- …research, financial modeling, and analysis of complex healthcare claims data ( medical , pharmacy and ancillary) to deliver practical, actionable financial and even ... skills required to present analytical results and findings to healthplans' senior management team and key stakeholder meetings (PowerPoint) * Coordinates and… more
- Molina Healthcare (Sterling Heights, MI)
- …research, financial modeling, and analysis of complex healthcare claims data ( medical , pharmacy and ancillary) to deliver practical, actionable financial and even ... skills required to present analytical results and findings to health plans' senior management team and key stakeholder meetings (PowerPoint) + Coordinates and… more
- Molina Healthcare (Sterling Heights, MI)
- …Assist retrospective HEDIS rate tracking and supplemental data impact reporting. + Develop Medical Record Review project reporting to track progress and team ... data. + 3+ Years of experience in Analysis related to HEDIS rate tracking, Medical Record Review tracking, Interventions tracking for at least one line of… more