- Molina Healthcare (Warren, MI)
- …and demonstrate proficiency in running all applicable risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ... Performs analysis across multiple states and lines of business ( Medicare , Medicaid, Marketplace ACA). **KNOWLEDGE/SKILLS/ABILITIES** + Compiling and organizing… more
- Highmark Health (Lansing, MI)
- …drug benefit strategies, drug formularies, and programs specifically for the Medicare Advantage (MA) market. The incumbent will contribute to recommendations for ... Committee review. + Assist in the development and implementation of utilization management programs including but not limited to: prior authorization, dose and… more
- State of Michigan (MI)
- …to perform survey and certification activities on behalf of the Centers for Medicare and Medicaid Services ( CMS ). The health care surveyor position performs ... Surveyor Minimum Qualifications Test (SMQT) in accordance with the Centers for Medicare and Medicaid Services' standards and procedures. All positions must abide by… more
- University of Michigan (Ann Arbor, MI)
- …CPT/HCPCs, ICD-10-CM code assignments, and modifier assignment in accordance with Center of Medicare and Medicaid Service ( CMS ) Guidelines, AMA and AHA Official ... the information therein as mandated by law, professional standards, and Health System policies + Demonstrates excellent customer service skills in working with… more
- Behavioral Center of Michigan (Detroit, MI)
- …objectives of the Center and to effectively present information to management , committees, staff, patients, families, and licensing and regulating agencies. Vision: ... mandated regulations. Maintains compliancy with regulation changes affecting utilization management . Reviews patient recrods and evaluates patient progress. Performs… more
- Cognizant (Lansing, MI)
- …ICD-10 + Experience making payments with UB/institutional ( CMS -1450) and/or professional ( CMS 1500) claims + Knowledge of Medicare / Medicaid payment and ... Responsible for reviewing the data in the claim processing system and comparing with corresponding UB or HCFA paper...Assigning special projects or other duties as determined by management . **What you need to have to be considered:**… more
- Gentiva (Portage, MI)
- …Strong communication and documentation abilities. + Familiarity with regulatory guidelines including Medicare , Medicaid, CMS , and JCAHO standards. + Ability to ... Paid Time Off + 7 Paid Holidays + Wellness Programs (Telemedicine, Diabetes Management , Joint & Spine Concierge Care) + Education Support & Tuition Assistance +… more
- Henry Ford Health System (Southfield, MI)
- …SEMI. This includes oversight of care delivery, health plan operations, financial management , regulatory compliance, and culture. The CEO must be a strong ... safe, coordinated, and participant-centered care across all sites in compliance with CMS and state regulations. + Provide strategic oversight of health plan… more
- Henry Ford Health System (Detroit, MI)
- …areas. + Develops and maintains an adequate understanding of managed care, CMS and UNOS guidelines relative to transplantation and financial involvement, + ... computer skills required to operate a personal computer. + Organizational and time management skills required in order to maintain and prioritize daily work, weekly… more
- Molina Healthcare (Warren, MI)
- **Job Description** **Job Summary** Molina Pharmacy Services/ Management staff work to ensure that Molina members, providers, and pharmacies have access to all ... members, providers, pharmacists, pharmacies, and technicians to meet departmental and CMS standards. + Enforce HIPAA compliance standards and regulations while… more