- Corewell Health (Grand Rapids, MI)
- …and substantive desk or onsite medical record review. Responsible for preparing case file, final report and ensuring corrective action is taken if applicable. ... reports to document finding and maintain up to date case files. Case files to include documentation...and Federal laws related to fraud, waste or abuse, Medicare and Medicaid regulations, etc. + Ability to work… more
- St. George Tanaq Corporation (Lansing, MI)
- …Central or Mountain Time Zones. **Responsibilities** + Reviews medical records/ case file, writes a reconsideration/dispute resolution decision that is clear, ... medical and healthcare practices, policies and procedures + Participates in case specific verbal discussions + Conducts reviews of appeals/disputes with multiple… more
- Molina Healthcare (Detroit, MI)
- …and adherence to appropriate guidelines and support staff who have an ongoing member case load for regular outreach and management. + As a Lead RN provide support, ... HCS Department staff workload for adherence to the Policies, Procedures, Guidelines, Medicare Model of Care, and deadlines. Assures oversight and direction of… more
- SGI Global, LLC (Grand Rapids, MI)
- …a special emphasis on fraud matters involving federal health care programs including Medicare and Medicaid. The contractor will report to the Civil Division Chief of ... Follow USAO policies and protocols for the management of case data and records. + Organize and maintain documents...cull, load, organize, index, log, track, produce, and present case data using various software programs. + Utilize software… more
- Humana (Lansing, MI)
- …best practices including user research, concept testing, opportunity sizing, business case development, training, and de-risking barriers to scale + Prioritize ... to: user research and concept testing, opportunity sizing and/or business case development, product blueprints, data and/or technology requirements, and ability to… more
- Molina Healthcare (Ann Arbor, MI)
- …more years in one or more of the following areas: utilization management, case management, care transition and/or disease management. + Minimum 2 years of healthcare ... years supervisory/management experience in a managed healthcare environment. + Medicaid/ Medicare Population experience with increasing responsibility. + 3+ years of… more
- Corewell Health (Grand Rapids, MI)
- …action to align policies supporting cost containment activities. + Establishes process for case assignment to review and respond to Provider appeals. + Knowledge and ... timeliness standards to not delay claim processing in any case . + Makes sure staff are meeting production expectations....care payer + Experience working with government programs including Medicare , Medicaid and FEHB + CRT - Registered Health… more
- Banner Health (MI)
- …of accounts for specific patient types and specialties in combination with the Case Mix Index and case financial information to formulate productivity standards, ... and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General (OIG) and the Health… more
- Trinity Health (Ypsilanti, MI)
- …(pre-certifications, third-party authorizations, referrals) and contacts physicians and Case Management/Utilization Review personnel, as needed. Obtains and verifies ... authorizations (pre-certifications, third-party authorizations, referrals) and contacts physicians and Case Management/Utilization Review personnel, as needed. Obtains and verifies… more
- Tenet Healthcare (Commerce Township, MI)
- …b) Create and follow up on electronic referrals using the Tenet Case Management system, c) Review patient choice letters with patients/families for required ... signatures, d) Provide follow up Important Message to Medicare patients prior to discharge, e) Communicate with patients,...of the Care Team, f) Complete tasks assigned by Case Manager and Social Work staff, g) Make copies,… more