- Humana (Lansing, MI)
- …necessary. + Participate in special projects as assigned by your Supervisor or Manager **Use your skills to make an impact** **Required Qualifications** + Bilingual ... years. CarePlus strives to help people with Medicare, or both Medicare and Medicaid , achieve their best possible health and wellness through plans with benefits and… more
- Henry Ford Health System (Troy, MI)
- GENERAL SUMMARY: Under supervision of Manager and / or Director, support the managed care contracting function by performing necessary financial analysis to evaluate ... inpatient and high dollar outpatient payments for various payors, including MA, Medicaid and Commercial. 8. Create prospective and retrospective analyses to assess… more
- Molina Healthcare (MI)
- …intervention initiatives including all lines of business (Medicare, Marketplace, Medicaid ). Executes health plan's member and community quality focused interventions ... to identify opportunities for improvement + Surfaces to the Manager and Director any gaps in processes that may...+ 1 year of experience in Medicare and in Medicaid managed care + Experience with data reporting, analysis,… 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 ... + Responsible to escalate risks and issues in coordination with the lead / manager for status reporting + Responsible to enforce department standards as directed by… more
- Molina Healthcare (Grand Rapids, MI)
- …cases appropriately regarding complexity of medical or psychosocial needs and case manager experience (RN, LSW, other allied fields). + Oversees the staff use ... and/or participates in Interdisciplinary Care Team meetings. + Works with the Manager to ensure adequate staffing and service levels and maintains customer… more
- Molina Healthcare (MI)
- …we are seeking a (RN) Registered Nurse who must Compact RN Licensure._ _Case Manager RN will work in remote setting supporting our Medicare/ Medicaid population ... who have recently been admitted into Hospital. The Case Manager will support our members to ensure successful transition from inpatient to outpatient. Excellent… more
- Molina Healthcare (Grand Rapids, MI)
- …**Highly Qualified Candidates Will Have the Following Experience-** Digital Tag Manager Programs Salesforce Marketing Cloud Google or Adobe analytics (or similar) ... Google AdWords, Tag Manager systems, (Adobe or Google) CMS (content management system)...communicator, and a desire to improve processes **Preferred:** + Medicaid or Medicare Health Plan experience + Strong analytical… more
- Integra Partners (Troy, MI)
- …leadership duties, serving as both a mentor and performance manager for frontline staff. Salary: $75,000.00/Annually JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES ... overall team performance, escalating issues as needed to the UM Clinical Manager . + Ensure compliance with all regulatory, contractual, and accreditation standards… more
- Behavioral Center of Michigan (Detroit, MI)
- …educate the staff and physicians regarding charting. REPORTS TO: Utilization Review Lead/ Manager QUALIFICATIONS: + High School Diploma or equivalent. + Bachelor of ... those duties include all tasks requested by the UR Manager , CEO or Medical Director to meet the needs...knowledge + Regulations as set by the Centers for Medicare/ Medicaid Services + Skill in operating a personal computer… more
- Humana (Lansing, MI)
- …campus and datacenters. The primary responsibility of the Network Operations Manager will be to provide the highest quality network infrastructure environment ... for future budget forecasting and planning needs. + Communicate status updates to Manager of IT and other Senior business leaders where necessary. + Research and… more