- Humana (Lansing, MI)
- …test plans, test cases, and product requirements. + Participate in test case reviews and ensure alignment with stakeholder expectations. + Align testing activities ... are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. **Equal… more
- Genesis Healthcare (Lapeer, MI)
- …clinical management of the rehab department, including oversight related to case management, quality improvement, care planning, clinical utilization, and patient ... experience and one year of management experience. 5. A thorough knowledge of Medicare and third party billing is also required. Posted Salary Range USD $70,000.00… more
- Humana (Lansing, MI)
- …scientists, software engineers, and stakeholders to deliver high impact AI use case solutions. + Lead the development and maintenance ofcomplex machine learning ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Molina Healthcare (Ann Arbor, MI)
- …MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable State regulatory requirements, including the ... Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare Management + Certified Professional in… more
- Trinity Health (Howell, MI)
- …(pre-certifications, third-party authorizations, referrals) and contacts physicians and Case Management/Utilization Review personnel, as needed. Obtains and verifies ... of insurance and governmental programs, regulations and billing processes ( Medicare , Medicaid, Social Security Disability, Champus, and Supplemental Security Income… more
- Trinity Health (Grand Haven, MI)
- …condition as appropriate and in a timely manner, to the client's physician and/or Case Manager/designee and obtains orders for changes in the plan of treatment to ... nursing, therapy (physical, occupational, speech) and medical social work. We are Medicare -certified and accredited by The Joint Commission. Learn more about us at… more
- Henry Ford Health System (Novi, MI)
- …1. Compliance with all accreditors and regulators (JCAHO, Blue Cross, Medicare , HIPPA) 2. Participates in Departmental Quality Improvement initiatives, including but ... re-authorizations for service, providing timely feedback to referral sources and case managers. Research/Education 1. Participates in the education, either by… more
- McLaren Health Care (Port Huron, MI)
- …administrative duties assigned. **Essential Functions and Responsibilities:** * Seeks case supervision and consultation as appropriate. * Participates in discharge ... assessments. * Complete MDS and resident assessments (RAP's) as required by Medicare , federal, and state regulation. * Obtains assistance for resident by referring… more
- Humana (Lansing, MI)
- …+ Identify important clinical and experience problems and build the business case to solve them through application of clinical, analytical, and business expertise. ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Highmark Health (Lansing, MI)
- …system entities in response to external coding audits conducted by the Medicare Administrative Contractor, the RAC, MIC, ZPIC, etc. Determine appeal action, prepare ... Is responsible for or works with external resources to create and monitor inpatient case mix reports and the top 25 assigned DRGs/APCs in the facilities to identify… more