- Evolent (Lansing, MI)
- …operations this individual also works with our clinical team, which includes our medical reviews: LVNs, LPNs, and RNs along with our behavioral health reviewers: ... Opportunities to work collaboratively with other Utilization Management Leaders including our Director may also be available. **What You Will Be Doing:** + Reviewing… more
- Molina Healthcare (Sterling Heights, MI)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under-utilization. Assumes...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- University of Michigan (Ann Arbor, MI)
- NURSING SERVICES SENIOR DIRECTOR (CS Mott Children's Hospital: 8W Brandon Newborn Intensive Care Unit) Apply Now **Job Summary** The Senior Nursing Director for ... services within the Level IV NICU. The senior nursing director is responsible for developing and maintaining an environment...world and has been the site of many groundbreaking medical and technological advancements since the opening of the… 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
- CVS Health (Lansing, MI)
- …Health, Health Equity and Quality programs. 2. Collaborating with the Medical Management stakeholders both internally ( UM /CM, Pharmacy, Quality, network, ... excellence, achieving measurable health outcomes, and supporting quality and medical management in a highly matrixed environment. The CMO...and analyze data and trends at State level in: UM , CM, Pop Health and Health Equity in order… more
- Corewell Health (Grand Rapids, MI)
- …Priority Health - 1231 E Beltline - Grand Rapids Department Name PH - Executive Medical Director Employment Type Full time Shift Day (United States of America) ... Medical Management and Rx Operations, including credentialing, formularies, UM /CM, member engagement, policy development / alignment / synchronization. + Partner… more
- Humana (Lansing, MI)
- …eligible members. + Serves as a liaison between Humana utilization management ( UM ) operations and the State of Michigan regarding prior authorization reviews, ... terms. + Works in conjunction with the Quality Improvement Director to develop quantifiable metrics that can track and...+ Manages Michigan state reporting and collaborate with the UM operations teams to aggregate and analyze data and… more
- University of Michigan (Dearborn, MI)
- …knowledge and management experience. **Who We Are** The University of Michigan-Dearborn ( UM -Dearborn) is one of the three campuses of the University of Michigan ... system. UM -Dearborn is a comprehensive university offering high-quality undergraduate, graduate,...to + 2:1 match on retirement savings + Excellent medical , dental, and vision coverage starting on day one… more
- University of Michigan (Ann Arbor, MI)
- … Officer of Revenue Cycle and Billing Compliance position reports to the Executive Director University of Michigan Medical Group (UMMG) and Senior Associate Dean ... of Clinical Affairs, President UM Health Partners Medical Regional Group, and the Chief Financial Officer, Michigan Medicine. **Mission Statement** Michigan… more
- University of Michigan (Ann Arbor, MI)
- …**Career Interest** Director /Manager/Supervisor Healthcare Admin & Support Nursing- All Nursing Nursing- Medical Surgical Nursing- Nursing Management Apply Now ... Acute Care Medicine) Apply Now **Job Summary** 5B1 is a 33-bed medical /surgical unit that primarily includes patients admitted to the services of:… more