- Highmark Health (Lansing, MI)
- …**Minimum** + High school diploma or GED + Experience in pharmacy prescription claims processing/submission/payment. **Preferred** + Associate degree + ... job provides front line staff guidance, ensures effective and efficient delivery of Pharmacy call center services. Serves as first line reviewer in monitoring and… more
- Henry Ford Health System (Troy, MI)
- GENERAL SUMMARY: Reports to the Manager of Pharmacy Benefits and other delegated pharmacist. Facilitates the operations of the Pharmacy Care Management ... Department by organizing, improving, and implementing pharmacy benefit management policies and procedures. Major areas of responsibility include oversight of the … more
- AmeriHealth Caritas (Detroit, MI)
- …integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. ... the Supervisor of Medicare LTSS Operations, the Medicare LTSS Care Coordinator manages care coordination for Medicare beneficiaries with complex medical, behavioral… more
- Henry Ford Health System (Detroit, MI)
- …coverage for services including areas such as hospitalization, professional services, pharmacy , home health, rehabilitation, DME and organ procurement limitations. + ... queues in Epic to assist in the processing of claims . + Serve as a resource to inform patients...a full suite of home health offerings, virtual care, pharmacy , eye care and other health care retail. With… more
- Henry Ford Health System (Troy, MI)
- …SUMMARY: As an integral member of the HAP Medical Policy Team, the Project Coordinator will be responsible for research and guidance on coding such as CPT, HCPCS, ... HAP code-related committee meetings to resolve coding questions related to claims , configuration, benefits, new technology, fraud, compliance, and any other issue.… more
- State of Michigan (Lansing, MI)
- …physician review according to policy, the Utilization Reviewer actively monitors Medicaid claims data. Cases identified are prepared and assigned by the Utilization ... administration, medical technology, nuclear medicine technology, nursing, occupational therapy, pharmacy , physician assistant, physical therapy, radiologic technology, rehabilitation, respiratory… more