- Munson Healthcare (Grayling, MI)
- …that challenge current development/skill level. Business Knowledge + Demonstrates knowledge of healthcare operations along with the business and clinical areas ... Key Competencies and Skills Technical Knowledge + Intermediate knowledge of Microsoft Office applications and Internet Explorer required. + Ability to use… more
- Molina Healthcare (Grand Rapids, MI)
- JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery… more
- Molina Healthcare (Detroit, MI)
- …review, and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that ... services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes… more
- Molina Healthcare (Sterling Heights, MI)
- …member care. Essential Job Duties * Provides behavioral health oversight and clinical leadership for health plan and/or market specific utilization management and ... on psychiatric diagnoses and treatment. * Provides second level behavioral health clinical reviews, peer reviews and appeals. * Supports behavioral health committees… more
- Molina Healthcare (Sterling Heights, MI)
- JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary ... and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care… more
- Molina Healthcare (Warren, MI)
- …process improvements, tools, etc. * Integrates medical chart coding principles, clinical guidelines, and objectivity in performance of medical audit activities. ... Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions. * Audits inpatient medical records and generates… more
- Molina Healthcare (Grand Rapids, MI)
- …through contract valuation and analysis to ensure access to quality healthcare services for people receiving government assistance. Strengthens access to quality ... and develop payment strategies that give incentives to providers and healthcare systems that deliver better health, more affordably. Performs research, financial… more
- Molina Healthcare (Detroit, MI)
- …through contract valuation and analysis to ensure access to quality healthcare services for people receiving government assistance. Strengthens access to quality ... and develop payment strategies that give incentives to providers and healthcare systems that deliver better health, more affordably. Performs research, financial… more
- Molina Healthcare (Sterling Heights, MI)
- …and consultation for NCQA standards/guidelines for the plan including compliant clinical quality improvement activity (QIA) in collaboration with clinical ... practice patterns and recommends corrective actions as needed. * Fosters clinical practice guideline implementation and evidence-based medical practices. * Utilizes… more
- Molina Healthcare (Detroit, MI)
- JOB DESCRIPTION Job SummaryProvides non- clinical administrative support to utilization management team and contributes to interdisciplinary efforts supporting ... preferably within a health care environment supporting correspondence or clinical communications, or equivalent combination of relevant education and experience.… more