- Prime Therapeutics (Lansing, MI)
- …of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. + ... for drug services. + Will actively maintain a required case load and the activities to reach overall goals...appeals program. + Participates in meetings and consults with management on regular basis to discuss member interaction and… more
- Corewell Health (Grand Rapids, MI)
- …You will lead cross-functional efforts, ensuring interdependencies across Network Contracting, Utilization Management , and Billing Policy are effectively managed ... action to align policies supporting cost containment activities. + Establishes process for case assignment to review and respond to Provider appeals. + Knowledge… more
- R1 RCM (Detroit, MI)
- …across multiple specialties. + Serve as a clinical resource to medical and case management staff by providing identification, facilitation, and resolution of ... by reviewing payor peer-to-peer cases. Every day you will review cases for which authorization has been denied evaluating...documentation and utilization issues. **Required Skills:** + Active, unrestricted MD or… more
- AmeriHealth Caritas (Southfield, MI)
- …an acute care, home care, or special needs clinic. + 3+ years of Case Management experience, preferably telephonic within a managed care organization, desired. ... + Current and unrestricted Registered Nurse licensure. + Eligible to sit for Case Management certification after 12 months of employment. Must obtain this… more
- AmeriHealth Caritas (Southfield, MI)
- …care, home care, or special needs clinic is required + 3+ years of Case Management experience, preferably telephonic within a managed care organization, desired. ... for work related events/meetings **Skills & Abilities** + Eligible to sit for Case Management certification after 12 months of employment. Must obtain this… more
- Centene Corporation (Detroit, MI)
- …with the local medical community, including periodic consultation with providers or prescribers. + Review case management data, identifies trends and gaps in ... required 7+ years clinical experience in the practice of medicine required Management experience preferred Utilization Management experience and knowledge… more
- McLaren Health Care (Flint, MI)
- …or other health care setting. **Preferred:** + One (1) year Managed Care Utilization review experience. + Experience and knowledge of the preauthorization ... members of all product lines, including communication to the case managers. Works with the PCP, the member and... managers. Works with the PCP, the member and management to promote the delivery of quality services at… more
- Molina Healthcare (Detroit, MI)
- …leadership and expertise in the performance of prior authorization, inpatient concurrent review , discharge planning, case management and interdisciplinary ... Molina Medical Director + Demonstrated experience in Utilization /Quality Program management + Previous leadership experience + Peer review , medical… more
- Mondelez International (Farmington, MI)
- …, pallets management . **How you will contribute** You will: + Review and analyze stock inaccuracies and guarantee accurate stock alignment between SAP and ... and external (third-party logistics vendors) business partners to ensure effective management , timely solutions and execution. You will also be responsible for… more
- Grace Health (Battle Creek, MI)
- … management for patients of all ages. 2. Provides direct patient care, case management , consultation and collaboration with other team members in the ... 9. Provides the highest quality nursing care through the utilization or conduction of research in nursing practice, standard...ANA, Health Policy, etc.) 12. Participates in required risk management peer review activities. 13. Conducts medical… more