- Atlas Healthcare Partners (Grand Rapids, MI)
- Corewell Health Orthopedic Surgery Center - E. Beltline, managed by Atlas Healthcare Partners, is situated within the Orthopedic Health and Performance Center in ... physician orders and the nursing plan of care, in compliance with policies and procedures, standards of care, and... with policies and procedures, standards of care, and regulatory agency requirements. Promotes continuity of care by accurately… more
- DuPont de Nemours, Inc. (Hemlock, MI)
- …System Software Validation to ensure new systems and system changes are managed consistently with regulatory & business requirements. Support cross-functional ... Quality Improvement initiatives (short-term & long-term) for our Liveo (TM) Healthcare operations; this involves supporting our customers and production sites. This… more
- Molina Healthcare (Ann Arbor, MI)
- …Degree in Healthcare Administration **Preferred Experience** + 10 years of managed care experience ( Regulatory and Compliance ) + Previous management ... Administration such as oversight, audit, etc. **Required Experience** * 7 years of managed care experience ( Regulatory and Compliance ) * Previous management… more
- Molina Healthcare (Sterling Heights, MI)
- …dynamics, and the latest Medicaid trends, positioning Molina as a leader in Medicaid managed care + Track regulatory compliance and address any operational ... and experience + 7 years in market strategy, business development, or healthcare consulting, specifically within Medicaid managed care or equivalent related… more
- Molina Healthcare (Sterling Heights, MI)
- …environment. * 3+ years experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, ... group and hospital contracting, etc. * Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and… more
- Molina Healthcare (Grand Rapids, MI)
- …review. The position may also work with other internal departments, including Compliance , Corporate Legal Counsel, and Medical Officers in order to achieve and ... various internal customers (eg, Provider Services, Contracting and Credentialing, Healthcare Services, Member Services, Claims) to gather documentation pertinent to… more
- DuPont (Hemlock, MI)
- …System Software Validation to ensure new systems and system changes are managed consistently with regulatory & business requirements. + Support cross-functional ... Quality Improvement initiatives (short-term & long-term) for our Liveo (TM) Healthcare operations; this involves supporting our customers and production sites. This… more
- Molina Healthcare (Ann Arbor, MI)
- …+ Review Medicaid COB claims for correct secondary pricing logic and compliance with configuration and regulatory rules. + Analyze claim outcomes ... our Payment Integrity and Claims Operations teams in ensuring the accuracy and compliance of Coordination of Benefits (COB) claim pricing and processing. This role… more
- Molina Healthcare (Sterling Heights, MI)
- …appropriate and correct clinical decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) ... knowledge, knowledge of all relevant and applicable Federal and State regulatory requirements and guidelines, knowledge of Molina policies and procedures, and… more
- Molina Healthcare (Grand Rapids, MI)
- …that support continuous quality improvement of the provider database, compliance with regulatory /accreditation requirements, and Network Management business ... equivalent combination of education and experience **Required Experience** + 3-5 years managed care experience, including 2+ years in Provider Claims and/or Provider… more
