- Molina Healthcare (Sterling Heights, MI)
- …with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/ IPA practice, capitation, HMO regulations, managed healthcare systems, quality ... improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence-based guidelines. + Experience in Utilization/Quality Program management + HMO/Managed care experience **PREFERRED LICENSE, CERTIFICATION,… more
- CVS Health (Lansing, MI)
- …for contract negotiations, involving all provider types including at-risk arrangements, IPA /PHO, hospital, and large provider groups. + Providing a solid ... understanding and expertise in the end- to-end aspects of provider contracting from modeling, configuration, utilization management, claims and analytics, including provider risk sharing. + Negotiating complex contract language and initiate legal reviews as… more
- CenterWell (Lansing, MI)
- …+ A minimum of three years Medical Coding experience or similar (including IPA and Offshore coding management) + RHIA, RHIT, CCS, or CPC Certification + ... Ability to travel both locally and overnight. **Preferred Qualifications:** + Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, and PowerPoint + Ability to communicate effectively and sensitively with clinicians and team… more
- Pine Rest Christian Mental Health Services (Grand Rapids, MI)
- …on Accreditation of Physician Assistant Programs + Physician Assistant Certified IPA -C) by NCCPA National Commission on Certification of Physician Assistants + ... Physician's Assistant license in the State of Michigan + Michigan Controlled Substance License + DEA registration + Current BLS Certification from American Heart Association or American Red Cross + Ability to accurately evaluate and care for the medical needs… more
- Cardinal Health (Lansing, MI)
- …new Payor contracts with Health Insurance companies (ex. Blue Cross, Blue Shield, IPA , etc). Reporting to the Director of Managed Care, the Manager of Contracting ... is responsible for managing legal review, policy compliance, contract retention and administrative tracking of all various managed care payors. Advances company payor strategy and aligns negotiation with strategy. **Essential Functions:** + In collaboration… more