- Evolent (Lansing, MI)
- …and provides clinical rationale for standard and expedited appeals. . Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... completed by the subject matter expert. . Discusses determinations ( peer to peer phone calls) with requesting...Clinical Reviewers. . Ensures documentation of all communications with medical office staff and/or MD provider is… more
- Evolent (Lansing, MI)
- …+ Provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... completed by the subject matter expert. + Discusses determinations ( peer to peer phone calls) with requesting...Clinical Reviewers. + Ensures documentation of all communications with medical office staff and/or MD provider is… more
- Evolent (Lansing, MI)
- …when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... completed by the subject matter expert. + Discusses determinations ( peer to peer phone calls) with requesting...expedited appeals. + Ensures documentation of all communications with medical office staff and/or MD provider is… more
- Evolent (Lansing, MI)
- …and provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... completed by the subject matter expert. + Discusses determinations ( peer to peer phone calls) with requesting...Clinical Reviewers. + Ensures documentation of all communications with medical office staff and/or MD provider is… more
- Elevance Health (Dearborn, MI)
- …for employment, unless an accommodation is granted as required by law. The ** Medical Director-Dermatology Appeals** is responsible for the review of appeals for ... of care opportunities. May serve as a resource to staff including Medical Director Associates. May be...clinical operational aspects of a program. + May conduct peer -to- peer clinical reviews with attending physicians or… more
- Henry Ford Health System (Flint, MI)
- …customers, and develops a plan for continual improvement. (Does not include formal peer review .). + Complete yearly safety and unit specific education ... of plan of care. + Collaborate with patient/family, hospital staff , and community agencies to develop discharge plans that...tests ordered are expeditiously carried out and documented. + Review patient medical record/reports and confers with… more
- Corewell Health (Troy, MI)
- …priorities. Present relevant data at medical staff meetings, medical executive committees, department meetings. Review data with individual physicians as ... MDQ provides clinical, administrative, and strategic oversight to all staff , including medical staff , responsible...VPMA and MDQ for service lines to ensure robust peer review activity is being maintained. Annual… more
- Tenet Healthcare (Detroit, MI)
- …Revenue Cycle meeting, researching disputes, uncovering patterns/trends, and educating hospital and medical staff on actionable items * Implements and monitors ... data to drive hospital utilization performance improvement, c) ensures medical necessity review processes are completed accurately...education * Completes initial and annual competency and evaluation review on all case management staff *… more
- Molina Healthcare (Warren, MI)
- …* Experience with utilization/quality program management. * Managed care experience. * Peer review experience. * Certified Professional in Healthcare Management ... * Implements behavioral health specific clinical practice guidelines and medical necessity review criteria. * Tracks all...national, state, and local laws and regulatory requirements affecting medical and clinical staff . * Ability to… more
- Henry Ford Health System (Detroit, MI)
- Position Description Overview In collaboration with the Medical Director of Infection Prevention and Control (IPC) and Antimicrobial Stewardship (AMS), the Associate ... Medical Director of IPC/AMS is responsible for implementation and...and appropriate use of antimicrobial agents. This includes the review of root cause analysis for healthcare associated infections… more