- Molina Healthcare (Grand Rapids, MI)
- …systems/programmer analysts on software applications, business domain and design standards. *Conducts peer review of other analysts (internal and contract staff) ... software engineers on multiple projects for project deliverables, assess deliverables' quality , plan and implement corrective and preventive actions to improve… more
- McLaren Health Care (Port Huron, MI)
- **Department:** Utilization Review **Daily Work Times:** 8:00am-4:30pm **Hours Per Pay Period:** 40 **Position Summary:** Responsible for determining the appropriate ... tools to document including Veracity, Optum, InterQual, Milliman, etc. 6. Facilitates peer to peer reviews with payer/providers. 7. Actively participates in… more
- NTT America, Inc. (Lansing, MI)
- …cause. + Ability to develop and take new design concepts through detailed design, peer review , executive review , construction, and operation. + Thorough ... quality and timeliness of the AE's performance. + Review and approval of consultant invoices. + Interaction with...AE Consultants. + Contributes to the continuous development of program standards and specifications. + Provide guidance to all… more
- Molina Healthcare (MI)
- …Public Health, Healthcare Administration, etc. **PREFERRED EXPERIENCE:** + Peer Review , medical policy/procedure development, provider contracting ... adjustment, disease management, and evidence-based guidelines. + Experience in Utilization/ Quality Program management + HMO/Managed care experience **PREFERRED… more
- Evolent (Lansing, MI)
- …as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. . Aids and acts as a resource to Initial ... reviews to be completed by the subject matter expert. . Discusses determinations ( peer to peer phone calls) with requesting physicians or ordering providers,… more
- Evolent (Lansing, MI)
- … Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Ensures documentation of all communications with ... + Provides clinical rationale for standard and expedited appeals. + Discusses determinations ( peer to peer phone calls) with requesting physicians or ordering… more
- Evolent (Lansing, MI)
- …as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Aids and acts as a resource to Initial ... reviews to be completed by the subject matter expert. + Discusses determinations ( peer to peer phone calls) with requesting physicians or ordering providers,… more
- Cardinal Health (Lansing, MI)
- …corrective action, not limited to termination when applicable. + Continually monitor program adherence, quality , attendance, and address accordingly. + Report ... patients can access, afford and remain on the therapy they need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to… more
- Stryker (Portage, MI)
- …teams, and program management to deliver products + Execute project plans + Review peer designed drawings + Contribute to the building and testing of ... with Marketing, R&D, Cost Accounting, and Advanced Sourcing, Advanced Quality , and Validation team members. You will serve as...and result analysis + Lead and/or participate in process review meetings. + Participate in Process Failure Mode and… more
- Henry Ford Health System (Grand Blanc, MI)
- …customers, and develops a plan for continual improvement. (Does not include formal peer review .). + Complete yearly safety and unit specific education ... length of stay, use of resources, and achievement of quality outcomes. + Provide patient care that reflects a...+ Orientation Self-Evaluation: (C) Competent (NT) Needs Training or Review . - Standards of Performance: - Seven Domains of… more