- AmeriHealth Caritas (Detroit, MI)
- …Medicaid and provider data management preferred. + 5 to 10 years of experience in managed care or the healthcare industry. + Prior experience working with ... + Maintain and communicate up-to-date knowledge of plan policies, procedures, and regulatory changes to providers. + Ensure provider network adequacy and … more
- Trinity Health (Chelsea, MI)
- …upon hire and ongoing as new systems and processes are created. Maintains compliance with HIPAA and other regulatory requirements throughout all activities. ... and assignment of benefits required. Provides information to patients concerning regulatory requirements. At point of service, provides estimated costs and patient… more
- Henry Ford Health System (Troy, MI)
- …Grievance department managers and other team members on provider appeals ensuring compliance with regulatory mandates including NCQA, Department of Labor (DOL) ... for Member appeals with a medical component to ensure these responses meet the regulatory requirements for every product line. + Assist with follow-up for all Member… more
- Humana (Lansing, MI)
- …Implement process improvements to enhance data accuracy, reporting efficiency, and compliance with regulatory requirements, ensuring continuous improvement and ... opportunity for a motivated individual to influence the mission of a leading healthcare company committed to improving the health of the communities it serves.… more
- CVS Health (Lansing, MI)
- …in quality data analysis, quality improvement projects, and regulatory compliance activities. Collaborates with the healthcare quality team to develop ... + Educates internal and external stakeholders on HEDIS program needs and compliance requirements. + Generates and interprets healthcare data reports and… more
- Prime Therapeutics (Lansing, MI)
- …contracts, participation requirements, analysis of pharmacies, and ensuring contract and regulatory compliance . This position is accountable for creation and ... rules inclusive of approved preferred and specialty pharmacies; maintain key compliance criteria and implement quarterly reporting processes for all contracted… more
- University of Michigan (Ann Arbor, MI)
- …is to attract, inspire, and develop outstanding people in medicine, sciences, and healthcare to become one of the world's most distinguished academic health systems. ... including: + Multiple inpatient services, including high-acuity critical care units, managed by PCCM. + Robust outpatient and procedural programs across both… more
- AmeriHealth Caritas (Southfield, MI)
- …providers and other care team members to improve the Member's health status, compliance with treatment plans and promote self-management. The Care Manager is also ... Member insurance products and benefits, community resources and programs, and applicable regulatory , state, and NCQA requirements. + May identify cases to be… more
- AmeriHealth Caritas (Southfield, MI)
- Your career starts now. We're looking for the next generation of healthcare leaders. At AmeriHealth Caritas, we're passionate about helping people get care, stay ... well, and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions… more
- Trinity Health (Livonia, MI)
- …supervisors. Retains accountability for staff coordination, training, hiring, performance, regulatory compliance , and results. Develops departmental plans, ... operational initiatives including new services/programs, revenue enhancement, expense reduction, managed care utilization systems, and strategies. Responsible for ensuring… more
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