- CenterWell (Lansing, MI)
- **Become a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health ... claims. The Medical Director , Primary Care work assignments involve moderately complex to...data requires an in-depth evaluation of variable factors. The Medical Director relies on medical … more
- Humana (Lansing, MI)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical… more
- Humana (Lansing, MI)
- …Become a part of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to ... per month with compensated days off during the work week The Medical Director 's work includes reviewing of all submitted medical records, synthesizing… more
- Integra Partners (Troy, MI)
- The UM Coordinator assists and supports the clinical team ( UM Nurses/ Medical Director ) with administrative and non-clinical tasks related to processing ... with authorization requests + Contact requesting providers to obtain medical records or other necessary documentation related to specific...& external sources + Other duties as assigned by UM Director + Strong organizational skills, ability… more
- Molina Healthcare (MI)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM ...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Molina Healthcare (Detroit, MI)
- …Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... * Provide regional medical necessity reviews and cross coverage * Standardizes UM practices and quality and financial goals across all LOBs * Responds to… more
- University of Michigan (Ann Arbor, MI)
- CLINICAL NURSING DIRECTOR (CS Mott Children's Hospital: 10-West Pediatric Cardiothoracic Intensive Care Unit- PCTU) Apply Now **Job Summary** The Pediatric ... from state, regional, national, and international referrals. PCTU specializes in the medical and surgical care of infants, children, adolescents, and adults with… more
- Molina Healthcare (Detroit, MI)
- JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting ... and cost-effective member care. Essential Job Duties * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports… more
- University of Michigan (Ann Arbor, MI)
- Admin Director Healthcare Apply Now **Job Summary** The Senior Director for Enterprise Disinfection & Sterilization Services is responsible for providing ... of sterile reprocessing departments, preferably in a large academic and/or complex medical facility. + Subject matter expertise of medical device reprocessing,… more
- Integra Partners (Troy, MI)
- …policies). + Review and process clinical and administrative appeals; coordinate with Medical Director when required. + Generate and review daily/weekly reporting ... The Utilization Management ( UM ) Nurse Supervisor is responsible for providing direct...with DMEPOS authorization and appeals processes. + Knowledge of medical necessity criteria (InterQual, CMS, health plan policies). +… more