- Molina Healthcare (Sterling Heights, MI)
- …complex business challenges that impact cost containment and regulatory compliance . The position requires strong business judgment, cross-functional coordination, ... Ownership** + Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay… more
- CenterWell (Lansing, MI)
- …delivery of associate-facing contact center technologies that support Pharmacy and Medicare Part D operations. This enterprise-wide platform empowers associates to ... a related field. **Preferred Qualifications:** + Understanding of pharmacy operations and Medicare Part D. + Experience with contact center platforms and CRM… more
- Hospice of Michigan (Traverse City, MI)
- …external partners to maintain high-quality standards of care and regulatory compliance . The specialist manages essential workflows within the electronic health ... Processes Notice of Non-Coverage Forms for signature after completion by clinical manager and team physician. Follows up as needed to ensure regulatory requirements… more
- Hospice of Michigan (Southfield, MI)
- …record (EHR), and coordinating with internal and external stakeholders to maintain compliance with hospice regulatory standards. The assistant serves as a vital link ... to meet regulatory requirements. + Maintains working knowledge of hospice Medicare Conditions of Participation and state-specific regulations to support compliant… more
- CenterWell (Lansing, MI)
- …Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare /Medicaid Experience a plus + Current nursing ... of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Molina Healthcare (MI)
- …quality member intervention initiatives including all lines of business ( Medicare , Marketplace, Medicaid). Executes health plan's member and community quality ... to identify opportunities for improvement + Surfaces to the Manager and Director any gaps in processes that may...skills. **PREFERRED QUALIFICATIONS:** + 1 year of experience in Medicare and in Medicaid managed care + Experience with… more
- CenterWell (Lansing, MI)
- …quality and cost improvement for high-risk senior populations in full risk Medicare arrangements. This individual will help assess the value of each opportunity ... quality and value drivers in full risk care delivery, ideally in Medicare /seniors + Demonstrated ability to work collaboratively with clinical and operational… more
- Highmark Health (Lansing, MI)
- …drug benefit strategies, drug formularies, and programs specifically for the Medicare Advantage (MA) market. The incumbent will contribute to recommendations for ... and testing processes in partnership with the pharmacy benefits manager . The successful candidate will possess excellent communication, analytical, and… more
- Trinity Health (Livonia, MI)
- …Type:** Full time **Shift:** **Description:** At the direction of the Regional Manager and Supervisor, Coding, this position is responsible for implementation and ... ongoing activities of the coding quality and compliance plan for the assigned Regional Health Ministries (RHMs)....coding and abstracting to the Regional Supervisor and Regional Manager . Assists with denials, complex coding cases, claim edits… more
- Evolent (Lansing, MI)
- …to find the most valuable defects. The IQA reports to a associate director or a manager . One or many IQAs may be engaged in any testing effort **What You Will Be ... risks and issues in coordination with the lead / manager for status reporting + Responsible to enforce department...Good knowledge US Healthcare - Payer side, Knowledge of Medicare , Medicaid, Commercial Plans and understanding on claims workflow,… more