- Corewell Health (Grand Rapids, MI)
- Job Summary The Medicare Quality Specialist , Pharmacy will assist the Medicare Adherence Pharmacists Team to improve Medicare Star Ratings and ... jargon to ensure understanding + Process refill requests through pharmacy or provider + Assist with correcting pharmacy...CMS requirements and standards + Other projects assigned by Medicare Quality Manager and/or Director How Corewell… more
- Amgen (Detroit, MI)
- …and transform the lives of patients while transforming your career. **Field Reimbursement Specialist - Detroit, MI** **What you will do** Let's do this. Let's change ... the world. In this vital role the Field Reimbursement Specialist (FRS) will manage defined accounts within a specified...the products are covered under the benefit design (Commercial, Medicare , Medicaid) + Serve as a payer expert for… more
- Highmark Health (Lansing, MI)
- …to Government Markets (STARS, ACA, CHIP, Medicaid DE) and Enterprise Quality , Safety, and Values (Health Outcomes Measures). Provide actionable opportunities in ... provider transformation aimed at high- quality , cost-effective care while improving patient outcomes. + Provide...requirements and CMS Stars rating measures including HEDIS, CAHPS, Pharmacy , HOS, PQA, PQRS. + Supportdevelopment of the overall… more
- Henry Ford Health System (Detroit, MI)
- …Under the direction of the department director, the Education Specialist assesses, designs, and evaluates cost-effective, customer-oriented, educational programs ... that are aimed at improving the quality of case management. Provides direction and consultation to Case Managers, clerical staff, and departmental management.… more
- AmeriHealth Caritas (Detroit, MI)
- … specialist responsible for supporting the daily operations of Medicare Member Services (Personal Service Program), integrated care management, and utilization ... integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.… more
- Molina Healthcare (Warren, MI)
- …Utilization Management and Long-Term Services & Supports issues. + Identifies and reports quality of care issues. + Prepares and presents cases in conjunction with ... or equivalent experience (such as specialties in: surgical, Ob/Gyn, home health, pharmacy , etc.). + Experience demonstrating knowledge of ICD-9, CPT coding and HCPC.… more