- Integra Partners (Troy, MI)
- …as operational needs require. The Senior MD provides clinical oversight to the Utilization Review Medical Director (s), ensures consistent application ... Integra's clinical position to internal and external stakeholders. The Senior Utilization Review Medical Director 's responsibilities include but are… more
- Integra Partners (Troy, MI)
- The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to ... and are committed to consistency, compliance, and evidence-based decision making. The Utilization Review Medical Director 's responsibilities include but… more
- Integra Partners (Troy, MI)
- The UM Coordinator assists and supports the clinical team (UM Nurses/ Medical Director ) with administrative and non-clinical tasks related to processing ... Utilization Management prior authorization sand appeals. JOB RESPONSIBILITIES +...RESPONSIBILITIES + Monitor incoming faxes + Enter UM authorizations review requests in UM platform using ICD-10 and HCPCS… more
- Molina Healthcare (Sterling Heights, MI)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... + 3+ years relevant experience, including: + 2 years previous experience as a Medical Director in a clinical practice. + Current clinical knowledge. + Experience… more
- Molina Healthcare (Sterling Heights, MI)
- …in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership ... utilization . * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy … more
- Molina Healthcare (Sterling Heights, MI)
- …Board Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease… more
- Molina Healthcare (Sterling Heights, MI)
- …reviews behavioral health portions of state contracts. * Assists behavioral health medical director lead trainers in the development of enterprise-wide education ... programs and chemical dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies… more
- Molina Healthcare (Sterling Heights, MI)
- …practice experience, and at least 2 years as a medical director in managed care setting supporting utilization management/quality management initiatives, or ... care team (ICT) activities. * Recruits, hires, trains, mentors and develops medical director staff as needed. * Ensures that authorization decisions… more
- Erickson Living (Novi, MI)
- …and dehydration. + Participating in Wound Rounds, Operations Meetings, Utilization Review , and Performance Improvement/Risk Management/Safety (PI/RM/S) ... Erickson Senior Living Join our team as the Assistant Director of Nursing is responsible for clinical leadership and...which builds on our mission, vision and values + Medical , dental and vision packages, including an annual reimbursement… more
- Corewell Health (Royal Oak, MI)
- …patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). 2. ... status and level of care. Uses defined resources to guide decisions, including Medical Director Care Management, Physician Advisors, and management staff. 5.… more
- Trinity Health (Auburn Hills, MI)
- …care and education under the supervision of the Sleep Lab Manager and the Medical Director and consistent with standards established by the Association of ... Polysomnographic Technology. Record review and scoring of polysomnograms is an integral part...Ensure equipment is properly prepared for patient testing and utilization . 1. Prepare and calibrate equipment required for testing.… more
- Integra Partners (Troy, MI)
- …accreditation standards and achieve high-quality outcomes. The position will report to the Director of Medical Management and work closely with other departments ... responsible for coordinating and maintaining accreditation activities for the Utilization Management (UM) and Credentialing departments. This includes supporting… more