- Highmark Health (Lansing, MI)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job works collaboratively riskacross Highmark Health clinical areas to support clinical ... Compliance Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal policies, state, CMS,… more
- Pine Rest Christian Mental Health Services (Grand Rapids, MI)
- …and substance use disorders. We are much more than just the third largest non-profit behavioral health system in the country, our 220-acre main campus, and our ... a state-of-the-art psychiatric urgent care center and a soon-to-be-built pediatric behavioral health center, outpatient, inpatient, partial hospitalization (day… more
- Highmark Health (Lansing, MI)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most… more
- Henry Ford Health System (Troy, MI)
- …of contractual provisions and rates on behalf of HFHS Hospitals, Medical Group, Behavioral Health Services and other business units. 1. Independently evaluate ... Payors and facilitate resolution of contracting and operational issues, ie billing, utilization review , credentialing site visits, notification of site closures… more
- Corewell Health (Dearborn, MI)
- …referral resources, bereavement support, adjustment counseling, facilitating guardianships and behavioral health concerns (including psychiatric transfers). + ... inpatients and Partial program patients and also may perform utilization review for this patient population +...and innovation in the fields of orthopedics, neurosciences, women's health , heart & vascular, and cancer care. QUALIFICATIONS: +… more
- Henry Ford Health System (Detroit, MI)
- …contractual provisions and rates on behalf of HFHS Hospitals, Medical Group, Behavioral Health Services and other business units. 2. Independently evaluate ... between HFHS and Payors on contracting and operational issues, ie billing, utilization review , credentialing site visits, notification of site closures or… more
- Corewell Health (Troy, MI)
- …referral resources, bereavement support, adjustment counseling, facilitating guardianships and behavioral health concerns (including psychiatric transfers). + ... inpatients and Partial program patients and also may perform utilization review for this patient population2. Provides...- State of Michigan 5 Yrs required How Corewell Health cares for you + Comprehensive benefits package to… more
- Highmark Health (Lansing, MI)
- …designs, competitive position, product development, network options, strategic partnerships, utilization review , local/national client demographics and dentist ... confidentiality agreements. Monitor financial performance of contracts by tracking utilization and competitive environment, including group specific performance guarantees.… more
- Elevance Health (Dearborn, MI)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... fee for service and assisting nurses as needed with review of claims. Works with other Medicare Administrative Contractor...For Health Solutions and Carelon organizations (including behavioral health ) only, minimum of 5 years… more
- Pine Rest Christian Mental Health Services (Grand Rapids, MI)
- …and substance use disorders. We are much more than just the third largest non-profit behavioral health system in the country, our 220-acre main campus, and our ... a state-of-the-art psychiatric urgent care center and a soon-to-be-built pediatric behavioral health center, outpatient, inpatient, partial hospitalization (day… more