- Evolent (Lansing, MI)
- …Appropriately identifies and refers quality issues to the Senior Director of Medical Management or Medical Director . + Appropriately identifies potential ... and write clearly. + Reviews adverse determinations against criteria and medical policies + Creates adverse determination notifications that meet all accreditation,… more
- Tenet Healthcare (Detroit, MI)
- Group Director Utilization Review - 2506000536 Description : The Detroit Medical Center (DMC) is a nationally recognized health care system that serves patients ... to help people live happier, healthier lives. The hospitals of the Detroit Medical Center are the Children's Hospital of Michigan, Detroit Receiving Hospital, Harper… more
- Evolent (Lansing, MI)
- …Stay for the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in ... programs that include improvements to clinical effectiveness of utilization management ( UM ) and risk-based models.** + Process improvement and enhancement of… more
- CVS Health (Lansing, MI)
- …have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical ... and consistent responses to members and providers. As a Medical Director you will focus primarily on...UM (Utilization Management) experience *Active and current state medical license without encumbrances *M.D. or DO, Board Certification… more
- University of Michigan (Ann Arbor, MI)
- …review of issues among Michigan Medicine executive leadership, including the EVPMA/CEO, the UM Health Regional Network President, the Medical School Dean, UM ... Director , Strategic & Administrative Operations, Office of CEO/EVPMA...Time** Full-Time **Regular/Temporary** Regular **FLSA Status** Exempt **Organizational Group** Medical School **Department** MM CE Pres MS Benefits Appt… more
- Molina Healthcare (Warren, MI)
- **JOB DESCRIPTION** **Job Summary** The Medical Director for Specialty Medical Services & Market Performance will provide clinical expertise and support to ... quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to… more
- Molina Healthcare (Grand Rapids, 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
- 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
- Molina Healthcare (Sterling Heights, MI)
- …Services. * Trains grievance and appeals staff, customer/member services department, sales, UM and other departments within Molina Medicare and Medicaid on early ... 2 years in a manager role. * Experience reviewing all types of medical claims (eg HCFA 1500, Outpatient/Inpatient UB92, Universal Claims, Stop Loss, Surgery,… more
- University of Michigan (Ann Arbor, MI)
- …and completes performance evaluation for nursing with feedback from the senior nursing director , medical faculty, peer groups, and ACU triad. + Creates job ... NURSING SUPERVISOR (Ambulatory Care Services: Medical Specialties) Apply Now **Job Summary** To participate...Michigan Health, Michigan Medicine. To assist the Senior Nursing Director in planning and management of the patient care… more