- Ascension Health (Kalamazoo, MI)
- … management experience preferred. **Additional Preferences** There will be a dual focus on case management and utilization review in this position + ... **Details** + **Department:** Case Management + **Schedule:** Monday through...Case Management experience - Strongly preferred + Utilization … more
- Tenet Healthcare (Detroit, MI)
- Director of Case Management -...Oversees hospital utilization performance improvement and operational management of the site Case Management ... services. Integrates national standards for case management scope of services including: Utilization ...case management scope of services including: Utilization Management supporting medical necessity and denial… more
- United Therapeutics (Lansing, MI)
- …pulmonary diseases, and other orphan diseases. **How you'll contribute** The Associate Global PV Case Management Director plays a key role in management ... processing for commercial UT products, including PM GSD workflows; Maintain unified PM Case Management operating procedures and monitor systems to ensure all PM… more
- Behavioral Center of Michigan (Warren, MI)
- …all state mandated regulations. Maintains compliancy with regulation changes affecting utilization management . Reviews patient recrods and evaluates patient ... to patients. Documents review information in the HMS. Communicates results to the case management entity for the specific insurance payer. Enters billing… more
- Humana (Lansing, MI)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Case managers or Care managers on complex case management , including familiarity with social determinants...size of region or line of business. The Medical Director conducts Utilization Management of… more
- Humana (Lansing, MI)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Case managers or Care managers on complex case management , including familiarity with social determinants...size of region or line of business. The Medical Director conducts Utilization Management of… more
- Humana (Lansing, MI)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Case managers or Care managers on complex case management , including familiarity with social determinants...size of region or line of business. The Medical Director conducts Utilization Management of… more
- Amergis (Traverse City, MI)
- …+ Current RN licensure in state practicing + At least one year of Case Management experience preferred + Complies with all relevant professional standards ... The RN Case Manager is responsible for coordinatingcontinuum of care...pertinent to patient's needs/goals + Partners with the Program Director in development and reviewof the patient's individualized coordination… more
- Elevance Health (Dearborn, MI)
- …preferred. + Extensive orthopedic surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. For ... **Clinical Ops Associate Medical Director ** **Orthopedic Surgery** **Location:** This is a virtual...necessity of requests using clinical criteria. + Performs physician-level case review of musculoskeletal utilization requests. +… more
- CVS Health (Lansing, MI)
- …provide clinical, coding, and reimbursement expertise as well as directing case management when necessary. The Medical Director will act as a business and ... Care Delivery System eg, Clinical Practice and Health Care Industry. *Prior UM ( Utilization Management ) experience *Active and current state medical license in… more
- Molina Healthcare (Warren, MI)
- …+ Delivers a unified or fully Integrated DSNP Medicare and Medicaid model that ensures case management and utilization management work cohesively to ... manage the needs of members holistically + Supports case management transformation and Integrated case...State Registered Nursing (RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in… more
- Highmark Health (Lansing, MI)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member...need. **Preferred** + None **SKILLS** + Critical Thinking + Case Management + Customer Service + Oral… more
- Vail Resorts (MI)
- …or until the position is filled (whichever is first). **Summary:** The Director of Mountain Operations Insights is instrumental in driving operational advancements ... levels of the organization. As operations grow in complexity, the Director will shape strategies that drive enterprise-wide transformation. **Responsibilities:** +… more
- Molina Healthcare (Detroit, MI)
- …across Molina Health Plans & Segments. **KNOWLEDGE/SKILLS/ABILITIES** + Review existing case management standards and processes and establishes new standards ... to drive clinical excellence and quality results across the enterprise. + Identifies case management best practices and capabilities across all plans and Lines… more
- Verint Systems, Inc. (Lansing, MI)
- …enrollment processes, including obtaining and analyzing benchmark data and utilization data, identifying trends, preparing recommendations with impact assessments ... covering the four pillars. + Responsible for all aspects of leave management , 401(k), tuition reimbursement, paid time off, annual holiday schedules and worker's… more
- Intermountain Health (Lansing, MI)
- …analysis and total cost of ownership understanding and analysis, implements demand management strategies, utilization management strategies and supply ... Intermountain Healthcare. (c) This position also manages key stakeholder relationship management (CRM), coordinating complex and critical projects in the supply… more
- Molina Healthcare (MI)
- …Active, unrestricted State Registered Nursing (RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care ... gaps and barriers in implementation and compliance to AVP, VP and senior management . + Consultative role, develops business case methodologies for programs,… more
- Tenet Healthcare (Detroit, MI)
- …for case management scope of services including: Provides assistance to the Director of Case Management in the management of the department, ... and Compliance policies and Documentation training Assists the Director of Case Management in...Case Management and Compliance policies, Transition Management , Utilization Management , and other… more
- Corewell Health (Farmington Hills, MI)
- …for managing a case load of patients that includes facilitating utilization management , and/or care coordination during the patient's stay, planning and ... of care and cost effectiveness through the integration and functions of utilization management , and/or care coordination, discharge planning, and appropriate… more
- Corewell Health (Royal Oak, MI)
- …for managing a case load of patients that includes facilitating utilization management , and/or care coordination during the patient's stay, planning and ... of care and cost effectiveness through the integration and functions of utilization management , and/or care coordination, discharge planning, and appropriate… more