- Intermountain Health (Lansing, MI)
- …with Clinical Documentation Integrity (CDI) Registered Nurses (RN) and Intermountain Physician Advisors to review complex facility encounters and assign ... coding questions received by facility caregivers including CDI RNs, Quality and Physician Advisor Services MDs. This position supports higher level analytics for CDI… more
- Corewell Health (Canton, MI)
- …and documents on EPIC. Communicate with patients and physician /office regarding authorization/referral requirements. Obtain financial responsibility forms or ... completed electronic forms with patients as necessary. + Review /obtain/witness hospital consent forms, and Notice of Privacy Practices with patient/family. Screen… more
- Evolent (Lansing, MI)
- …is a key member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical Directors and interacts with ... well as health plan members and staff whenever a physician `s input is needed or required. Responsible for clinical...Manager. + Provides medical direction to the support services review process. Responsible for the quality of utilization … more
- Presbyterian Villages of Michigan (Chesterfield, MI)
- …how to assist them. 3. Administer prescribed medications as ordered by physician (s) or in response to emergency situations per medical directives. Document ... to medication or treatment, and taking any necessary action under direction of physician or registered nurse. 5. Provide basic resident care or treatments, including… more
- Highmark Health (Lansing, MI)
- …clinical review and decisions including but not limited to: physician and member appeals, member or provider information/education. + Participate on ... drug benefit strategies, drug formularies, and programs specifically for the Medicare Advantage (MA) market. The incumbent will contribute to recommendations for… more
- ChenMed (Eastpointe, MI)
- …documentation related to appointment, uploading into organization's medical record system for physician review prior to PCP follow-up appointment. + Ensures any ... understanding of the company's patient population, including the complexities of Medicare programs + Exceptional organizational skills with the ability to… more
- Elara Caring (Ludington, MI)
- …locations to meet patient needs. + Ensures compliance of current Medicare , Medicaid, and third-party reimbursement regulations and changes. Identifies and reports ... potential payment/coverage problems. + Supervises and coordinates utilization review activities. + Participates in strategic development of Key Accounts, including… more
- Molina Healthcare (Detroit, MI)
- …medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred ... requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care and services… more
- Evolent (Lansing, MI)
- …interacts with leadership and management staff, other Physicians, and staff whenever a physician `s input is needed or required. **What You Will Be Doing:** + Serve ... as the Physician match reviewer in Imaging cases, that do not...rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Lansing, MI)
- …interacts with leadership and management staff, other Physicians, and staff whenever a physician `s input is needed or required. **What You Will Be Doing:** . Serve ... as the Physician match reviewer in Advanced Imaging cases, that do...rationale for standard and expedited appeals. . Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more