- WK Kellogg Co (Battle Creek, MI)
- …Relations, and day-to-day Labor Relations activities such as accountability, discipline, grievances , arbitrations and negotiations. You will seek and employ creative ... solutions to persistent challenges. You will be a key member of the company negotiations team preparing for and engaging in the labor negotiations process. + Training & Development - In this role, you will be responsible for ensuring delivery of appropriate… more
- Molina Healthcare (Sterling Heights, MI)
- …corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees ... as required such as Credentialing, P&T and others as directed by the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review, and manages the denial process. + Monitors… more
- Highmark Health (Lansing, MI)
- …clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + Serve as a resource for technical staff. + Other duties ... as assigned or requested. **QUALIFICATIONS:** **Minimum** + High school diploma or GED + Experience in pharmacy prescription claims processing/submission/payment. **Preferred** + Associate degree + Pharmacy technician certification certificate + Experience… more
- Evolent (Lansing, MI)
- …clinical services (ie, specialty care, utilization management, care management, appeals & grievances ) + Using analytical tools to integrate various data sources to ... solve challenging analytical problems that align with key strategic objectives. + Developing reports that assess the value of our clinical programs or create monitoring tools to identify members with complex health needs. + Partnering with internal… more
- Fontana Fasteners (Holly, MI)
- …Confers with management or subordinates to resolve worker problems, complaints, or grievances . + Inputs information into electronic time and attendance systems. + ... Assists HR with hiring, training, discipline and termination of employees. + All other duties as assigned by the manager. Qualifications - Education / Experience Required: + 2-year technical degree or 8 years equivalent experience. + High school diploma or GED… more
- Prime Therapeutics (Lansing, MI)
- …denial. + Researches, resolves and documents physician or client inquiries and grievances and provides verbal or written results to client, prescriber, provider ... and/or management. + Performs other duties as required. + For CPTs assigned to work the fax queue, responsibilities will also include: + Clinically reviews coverage determinations with attention to detail, for medications via Fax. Communicates decision to… more
- Cognizant (Lansing, MI)
- …. Experience in utilization management to include Clinical Appeals and Grievances , precertification, initial and concurrent reviews . Intermediate Microsoft Office ... knowledge (Excel, Word, Outlook) . In-patient and outpatient experience **These will help you stand out** . Epic experience . Experience in drafting appeals disputing inpatient clinical validations audits is a plus. We're excited to meet people who share our… more
- City of Detroit (Detroit, MI)
- …such positions + Hears and resolves complaints from employees + Refers group grievances and the more serious complaints not resolved to managers or Executives + ... Recommends minor disciplinary measures such as warnings and reprimands + As needed, consult with specialists on training needs, and deciding on training problems related to the units supervised including training in ERP Cloud applications and new technologies… more
- Marriott (Detroit, MI)
- …and accomplish your work. * Handles complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others. * Participates in ... department meetings and continually communicates a clear and consistent message regarding the Front Desk goals to produce desired results. * Strives to improve service performance. * Observes staffing levels to ensure that guest service, operational needs and… more
- Molina Healthcare (Detroit, MI)
- …immediate and acute gaps in care and access. Assist members with filing grievances and appeals. * Connects members to CCEs, the OhioRISE Plan,or Molina Care ... Management if the members needs indicate a higher level of coordination. Provide information to members related to Molina requirements , services and benefits . * Knowledge of internal MCO processes and procedures related to Care Guide responsibilities… more
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