- Sedgwick (Lansing, MI)
- …Fortune Best Workplaces in Financial Services & Insurance Sr. VP Medical Director **PRIMARY PURPOSE** **:** To evaluate medical reports escalated due to deficient ... required to include one (1) to three (3) years utilization review experience and three (3) years clinical quality...+ Knowledge about general claim practices. + Knowledge of pharmacy processes and pharmacy benefit management a… more
- Prime Therapeutics (Lansing, MI)
- …fuels our passion and drives every decision we make. **Job Posting Title** Sr. Director Actuarial Forecasting - REMOTE **Job Description** The Senior Director of ... functional leadership to develop and maintain projected trend assumptions related to utilization , unit cost, and gross/net rebate assumptions + Owns the annual… more
- Henry Ford Health System (Detroit, MI)
- …an Infectious Diseases physician to serve as the System Associate Medical Director of Epidemiology and Infection Prevention and Antimicrobial Stewardship. Henry Ford ... expertise in IPC, healthcare epidemiology and antimicrobial stewardship; optimizing utilization of diagnostic testing and antimicrobials; and helping to develop… more
- CVS Health (Lansing, MI)
- …services with CVS Health's unrivaled presence in local communities and their pharmacy benefits management capabilities, we're joining members on their path to better ... an exciting opportunity to join its leadership team as an Executive Director , Network Management supporting our Michigan market for our Commercial, Medicare, IFP,… more
- Travelers Insurance Company (Lansing, MI)
- …collaboration with the Claim leaders and in partnership with other Medical and Pharmacy professionals. **What Will You Do?** + Provide overall program leadership as ... sustain quality results. + Partner with other medical and pharmacy experts on the development and design of training...Have?** + Licensed MD + 5 years clinical and utilization management experience + Certified by the American Board… more
- Highmark Health (Lansing, MI)
- …Drug Formularies by monitoring FDA-approvals and drug manufacturer pipelines, assessing drug utilization reports, and writing drug monographs for Pharmacy & ... overall efficiencies. + Manage individual projects for timely review with the Director , Clinical Pharmacy . + Participate in Medicare Stars performance measures… more
- CVS Health (Lansing, MI)
- …oversight of the design, development, and deployment of Care Management, Utilization Management, Population Health, Health Equity and Quality programs. 2. ... Collaborating with the Medical Management stakeholders both internally (UM/CM, Pharmacy , Quality, network, compliance, VBS team) and externally (Agency, regulators,… more
- Henry Ford Health System (Troy, MI)
- Reporting to Director or Manager, assist in the development of Contract Strategy and work directly with Payors to lead negotiation of contractual provisions and ... relevant contractual requirements and issues to internal customers such as Utilization Management, Finance, Patient Billing, Administration, Legal, etc. 7. Maintain… more
- Henry Ford Health System (Detroit, MI)
- …collaboration and team-oriented project work. This position reports to the Director Physician Engagement. PRINCIPLE DUTIES AND RESPONSIBILITIES: + Assist with ... the health system's physician referral outreach objectives, focused on expanded service utilization through the use of various marketing channels. + Produce and/or… more
- Henry Ford Health System (Detroit, MI)
- …collaboration and team-oriented project work. This position reports to the Director Physician Engagement. PRINCIPLE DUTIES AND RESPONSIBILITIES: + Assist in ... health system's physician and practice promotion objectives, focused on expanded service utilization through the use of various marketing channels. + Manage the… more