- Humana (Lansing, MI)
- …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... requires a case by case consideration of the Medicare rules, Humana policies and medical necessity. The Medical Director will collaborate with clinicians and… more
- CVS Health (Lansing, MI)
- …And we do it all with heart, each and every day. **Position Summary** The Lead Director , Pharmacy Appeals will lead a team of 40+ colleagues in the ... internal business units to resolve issues quickly. The Lead Director , Pharmacy Appeals is also...our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company… more
- CenterWell (Lansing, MI)
- **Become a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health ... claims. The Medical Director , Primary Care work assignments involve moderately complex to...overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their… more
- Humana (Lansing, MI)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...overview of coding practices and clinical documentation, grievance and appeals processes (including pharmacy ), and reviews for… more
- Molina Healthcare (Detroit, MI)
- …under-utilization. * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy ... reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. *… more
- Molina Healthcare (Detroit, MI)
- …Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... health and chemical dependency services. Works closely with the Regional Medical Directors to standardized utilization management policies and procedures to improve… more
- Henry Ford Health System (Detroit, MI)
- As the Director of Payer Audit - Revenue Cycle, you'll lead a high-performing, system-wide audit team and set the strategy for pre- and post-payment audit processes. ... and results, this is your opportunity to make a lasting impact. The System Director of Payer Audit provides strategic and operational leadership for all payer audit… more