- Corewell Health (Dearborn, MI)
- …referral resources, bereavement support, adjustment counseling, facilitating guardianships and behavioral health concerns (including psychiatric transfers). + ... inpatients and Partial program patients and also may perform utilization review for this patient population +...and innovation in the fields of orthopedics, neurosciences, women's health , heart & vascular, and cancer care. QUALIFICATIONS: +… more
- Highmark Health (Lansing, MI)
- …designs, competitive position, product development, network options, strategic partnerships, utilization review , local/national client demographics and dentist ... confidentiality agreements. Monitor financial performance of contracts by tracking utilization and competitive environment, including group specific performance guarantees.… 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)
- …+ Participate in product specific Pharmacy and Therapeutics Committees and Drug Utilization Review (DUR) Committees as necessary or contractually required. + ... position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of...with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as… 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
- Elevance Health (Dearborn, MI)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... law. The **Medical Director-Dermatology Appeals** is responsible for the review of appeals for physical health medical...For Health Solutions and Carelon organizations (including behavioral health ) only, minimum of 5 years… more
- Highmark Health (Lansing, MI)
- …effective application of appropriate design standards, methods, and tools. + Review application designs to ensure optimal technology selection, efficient resource ... utilization , and seamless system integration. + Ensure system architecture...automation scripts (Shell, Python) for streamlining tasks, ensuring peer review and version control. + Maintain comprehensive technical documentation,… more
- CenterWell (Lansing, MI)
- …Director of Physician Strategy at Utilization Management. The Medical Director conducts Utilization review of the care received by members in an assigned ... review organization, such as Medicare Advantage,managedMedicaid, or Commercial health insurance. + Experience with national guidelines such as MCG(R) or… more
- Sevita (Detroit, MI)
- …documentation; maintain confidentiality and adherence to individual rights standards; review and respond accordingly to adverse action regulatory correspondence and ... protocol; manage timely incident reporting and response to higher-level incidents; review trends; work with state operations and quality improvement leadership to… more