- CVS Health (Lansing, MI)
- …+ Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate ... care issues through established channels + Ability to speak to medical and behavioral health professionals to influence appropriate member care. + Utilizes… more
- Humana (Lansing, MI)
- …care management, provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and ... part of our caring community and help us put health first** The Behavioral Health ...insurance, other healthcare providers, clinical group practice management + Utilization management experience in a medical management review… more
- CenterWell (Lansing, MI)
- …best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can ... part of our caring community and help us put health first** Conviva Care Solutions is seeking a RN...medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part… more
- CenterWell (Lansing, MI)
- …best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can ... part of our caring community and help us put health first** Healthcare isn't just about health ...medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part… more
- CVS Health (Lansing, MI)
- …- 1+ years' current or previous experience in **Medical/Surgical,** **Oncology, Transplant, Behavioral Health or Specialty Pharmacy.** - 1+ years' experience ... At CVS Health , we're building a world of health ...lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC recognized… more
- Molina Healthcare (Grand Rapids, MI)
- …plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG… more
- Molina Healthcare (Detroit, MI)
- …plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. ... Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG… more
- CVS Health (Lansing, MI)
- …imperatives. 4. Provide clinical expertise to shape the integrative model of physical, behavioral , and health related resource needs to support holistic care and ... competitive business advantage by supporting the plan goals. 2. Review , interpret and analyze data and trends at State...of the design, development, and deployment of Care Management, Utilization Management, Population Health , Health … more
- Molina Healthcare (MI)
- …facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need ... or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina employees: If… more
- Highmark Health (Lansing, MI)
- …drug utilization reports, and write drug monographs for Committee review to develop the Organization's Drug formulary and/OR provide recommendations for NDC ... and stakeholders across the organization. Key responsibilities will include clinical review , assisting in navigating a complex regulatory environment, working with… more