- Humana (Lansing, MI)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Utilization management experience in a medical management review organization, such as Medicare Advantage... Case managers or Care managers on complex case management , including familiarity with social determinants… more
- University of Michigan (Ann Arbor, MI)
- …Surgery Scheduler is the central coordinator for surgical scheduling, ensuring efficient utilization of operating room time, staff and equipment. This role involves ... and other required test results and ensure consents are in place. + Schedule Management : + Utilize the electronic medical record to create and maintain the surgical… 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...need. **Preferred** + None **SKILLS** + Critical Thinking + Case Management + Customer Service + Oral… more
- Datavant (Lansing, MI)
- …###@datavant.com . We will review your request for reasonable accommodation on a case -by- case basis. For more information about how we collect and use your ... benchmarking, goal setting, timely execution, and superior leadership. + Strong utilization of SalesForce to include monitoring and documenting member information. +… more
- Highmark Health (Lansing, MI)
- …insights and guidance to internal departments. The Analyst conducts audits of Medical Directors, Utilization Management (UM) and Case Management (CM) ... Risk Compliance Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal policies,… more
- CVS Health (Lansing, MI)
- …expert and provide oversight of the design, development, and deployment of Care Management , Utilization Management , Population Health, Health Equity and ... with UM team and Plan clinical leaders to identify and effectively manage emerging utilization trends, large case reviews, and out of state service requests. 6.… more
- Molina Healthcare (Sterling Heights, MI)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and...the specific programs supported by the plan such as Utilization Review , Medical Claims Review ,… more
- Datavant (Lansing, MI)
- …###@datavant.com . We will review your request for reasonable accommodation on a case -by- case basis. For more information about how we collect and use your ... As a Salesforce System Architect, you will be responsible for user management , data maintenance, security configuration, and training users on using Salesforce… more
- Veterans Affairs, Veterans Health Administration (Battle Creek, MI)
- …other champions to improve processes to meet the performance measure goals and improve utilization management ; serving as a liaison to outside facilities when to ... Serves as a Mental Health leader for quality improvement initiatives and utilization management related to Psychiatry Service. Plans, coordinates and ensures… more
- Molina Healthcare (Grand Rapids, MI)
- …abuse through the identification of aberrant coding and/or billing patterns through utilization review . + Prepares appropriate FWA referrals to regulatory ... and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing...appropriately all case related information in the case management system in an accurate manner,… more