- Molina Healthcare (Warren, MI)
- …dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to ... -related regional medical necessity reviews and cross coverage. * Standardizes behavioral health -related utilization management, quality, and financial… more
- Tenet Healthcare (Detroit, MI)
- RN Utilization Review - Case Management -...preferred. At least two (2) years acute hospital or Behavioral Health patient care experience required. One ... level of care Mentor and monitor work delegated to Utilization Review LVN/LPN and/or Authorization Coordinator as...(1) year hospital acute or behavioral health case management experience preferred. Active… more
- CenterWell (Lansing, MI)
- …best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can ... part of our caring community and help us put health first** Conviva Care Solutions is seeking a RN...medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part… more
- Molina Healthcare (Detroit, MI)
- **JOB DESCRIPTION** **Job Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management and case management ... and chemical dependency services and assists with implementing integrated Behavioral Health care management programs. **Knowledge/Skills/Abilities** Provides… more
- Highmark Health (Lansing, MI)
- …SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health care services, application of ... utilization , identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues. Monitors… more
- Highmark Health (Lansing, MI)
- …business relationships, the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role involves ... units that may assist in the resolution of issues or problems. + Access, review , utilize, contribute content to and participate in the maintenance of the shared… more
- Pine Rest Christian Mental Health Services (Grand Rapids, MI)
- …and substance use disorders. We are much more than just the third largest non-profit behavioral health system in the country, our 220-acre main campus, and our ... a state-of-the-art psychiatric urgent care center and a soon-to-be-built pediatric behavioral health center, outpatient, inpatient, partial hospitalization (day… more
- Pine Rest Christian Mental Health Services (Grand Rapids, MI)
- …and substance use disorders. We are much more than just the third largest non-profit behavioral health system in the country, our 220-acre main campus, and our ... a state-of-the-art psychiatric urgent care center and a soon-to-be-built pediatric behavioral health center, outpatient, inpatient, partial hospitalization (day… more
- Highmark Health (Lansing, MI)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Highmark Health (Lansing, MI)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most… more