- Molina Healthcare (Ann Arbor, MI)
- …management experience. + 3+ years supervisory experience in a managed healthcare environment. **Preferred License, Certification, Association** Active, ... non-clinical team activities to facilitate integrated, proactive utilization management, ensuring compliance with regulatory and accrediting standards. + Manages… 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 (MI)
- …other Molina departments as needed + Writes narrative reports to interpret regulatory specifications, explain programs and results of programs, and document findings ... education and work experience. + 3 years' experience in healthcare with a minimum of 2 years' experience in...of 2 years' experience in health plan member interventions, managed care, or equivalent experience. + Demonstrated solid business… more
- Molina Healthcare (Detroit, 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 (Detroit, 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
- Molina Healthcare (Warren, MI)
- …opportunities for improvement of member outcomes + Oversees and ensures compliance with contractual, accreditation and regulatory requirements relative to ... **Job Description** **Job Summary** Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and… more
- Tenet Healthcare (Detroit, MI)
- …while assuring care is sequenced and at the appropriate level of care Compliance with state and federal regulatory requirements, TJC accreditation standards and ... system that serves patients and families throughout Michigan and beyond. A premier healthcare resource, our mission is to help people live happier, healthier lives.… more
- Molina Healthcare (Grand Rapids, MI)
- …that would affect job performance. **Preferred Experience** + 5 years in the healthcare industry, managed care organization or equivalent experience. + Knowledge ... team, assisting the team in understanding pharmacy quality, cost effectiveness and compliance and working closely with the Pharmacy Director or AVP to ensure… more
- Prime Healthcare (Garden City, MI)
- …to deemed agencies, state law, and other regulations to assure compliance . Responsibilities KEY RESPONSIBILITIES: + Maintains complete knowledge of hospital policy, ... comply with administrative and medical staff policy, as well as regulatory expectations and standards. + Develops processes which facilitate credentialing,… more
- Trinity Health (Ann Arbor, MI)
- …upon hire and ongoing as new systems and processes are created. Maintains compliance with HIPAA and other regulatory requirements throughout all activities. ... upon hire and ongoing as new systems and processes are created. Maintains compliance with HIPAA and other regulatory requirements throughout all activities.… more
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