- Molina Healthcare (Detroit, MI)
- …EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** * 2+ years of program and/or project management experience in risk adjustment and/or quality * 2+ years of ... Plan Risk and Quality leaders to improve outcomes by managing Risk/ Quality data collection strategy , analytics, and reporting, including but not limited… more
- Humana (Lansing, MI)
- …claims data used in **HEDIS measurement** + Familiarity with ** CMS Stars programs ** , NCQA standards, and quality performance metrics. + Advanced experience ... strategy , and roadmap for data products that enable CMS Stars and HEDIS reporting. Ensure alignment with enterprise...Knowledge of NCQA, CMS , and health plan quality measurement programs . + Deep understanding of… more
- Molina Healthcare (MI)
- …other standards and requirements pertaining to delegation agreements. Contributes to overarching strategy to provide quality and cost-effective member care. This ... with preparation of delegation summary reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. +… more
- Molina Healthcare (Sterling Heights, MI)
- …and ability to learn new programs . Preferred Qualifications * Experience with utilization/ quality program management . * Managed care experience. * Peer ... health care programs within specific markets/regions. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job… more
- Molina Healthcare (Sterling Heights, MI)
- …system analysis and program staff. These positions' primary focus is project/ program management . **Job Duties** + Active collaborator with people who are ... external vendors. + Focuses on process improvement, organizational change management , program management and other...Manager, Skilled Nursing, SNIP, SNIF, LTC, Medicare, Medicaid, Duals, CMS , Survey, Compliance, Quality , Quality … more
- CenterWell (Lansing, MI)
- …our caring community and help us put health first** The Program Management Lead, Offshore Coding Operations conducts quality assurance audits of medical ... for Medicare and Medicaid Services ( CMS ) and other government agencies. The Program Management Lead, Offshore Coding Operations works on problems of diverse… more
- Molina Healthcare (MI)
- …length of stay and level of care provided to members. Contributes to overarching strategy to provide quality and cost-effective member care. Candidates with UM ... Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ)… more
- Molina Healthcare (Warren, MI)
- …system analysis and program staff. These positions' primary focus is project/ program management , rather than the application of expertise in a specialized ... (training, SOPs, job aids, communications). + Risk, Compliance & Quality : Ensure alignment to CMS , HIPAA, state...education and experience **Required Experience** + 5-7 years of project/ program management with direct impact on Claims… more
- CenterWell (Lansing, MI)
- …teams. ** Quality and Compliance:** + Oversee coding quality assurance programs to ensure accuracy and compliance with CMS , HHS, and other regulatory ... (5) years leadership experience overseeing multifaceted teams + Experience in program management and analytics **Preferred Certifications:** + Master's degree… more
- Henry Ford Health System (Bingham Farms, MI)
- …within HAP and the HVPE. + Ensures and promotes customer service and total quality management + Serves in additional capacities and responsibilities as outlined ... across Health Alliance Plan (HAP) to ensure cost-effective, high- quality drug benefit programs for all covered...This leader will shape HAP's pharmacy benefit design, utilization management , PBM relationships, and formulary strategy to… more