• Medical Director-Dermatology Appeals

    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 ... law. The **Medical Director-Dermatology Appeals** is responsible for the review of appeals for physical health medical...For Health Solutions and Carelon organizations (including behavioral health ) only, minimum of 5 years… more
    Elevance Health (10/01/25)
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  • RN, Geriatric Acute Mental Healthcare

    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
    Pine Rest Christian Mental Health Services (08/09/25)
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  • Manager, Healthcare Services

    Molina Healthcare (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. ... multidisciplinary integration and collaboration to enhance the continuity of care including Behavioral Health and Long-Term Services & Supports for Molina… more
    Molina Healthcare (09/27/25)
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  • Senior Architect - Cloud

    Highmark Health (Lansing, MI)
    **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This role is responsible for designing, developing, implementing, supporting, and optimizing ... stakeholder concerns. **Key Responsibilities:** + Lead and participate in Architecture Review Board processes, providing expert guidance on cloud-based solutions and… more
    Highmark Health (07/22/25)
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  • Pharmacy Coordinator

    Highmark Health (Lansing, MI)
    …Wholecare's pharmacy programs with a focus on medication adherence and optimizing member health outcomes. This role involves a high volume of daily contacts with ... address medication-related issues, promote adherence, and ensure appropriate medication utilization . **ESSENTIAL RESPONSIBILITIES** + Communicate effectively with physicians and… more
    Highmark Health (09/19/25)
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  • Pharmacy Benefit Consultant

    Highmark Health (Lansing, MI)
    …**Preferred** + 5 years of experience with communications + 3 years of experience in Utilization Review + 3 years of experience in Account Support + 1 year ... **Substitutions** + 6 years experience in pharmacy or managed health care setting in lieu of Bachelor degree **Preferred**...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
    Highmark Health (08/26/25)
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  • Manager Software Engineering - AI Platforms…

    Highmark Health (Lansing, MI)
    **Company :** Highmark Health **Job Description :** Entirely Remote Work From Anywhere Role! We are seeking an experienced Software Engineering Manager to lead our ... have budgetary responsibility and authority. + Understand budget and resource utilization across the product teams. Escalate any issues regarding product delivery… more
    Highmark Health (08/08/25)
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  • RN Lead, Healthcare Services

    Molina Healthcare (Sterling Heights, MI)
    … utilization management, care transitions, long-term services and supports (LTSS), behavioral health , and other clinical programs, and collaborates with ... * Actively participates in the department auditing program to review , communicate findings and identify opportunities for improved quality...every work day and cases are addressed to maintain health rid assessment (HRA) and care plan compliance. *… more
    Molina Healthcare (09/26/25)
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  • Healthcare Services Operations Support Auditor

    Molina Healthcare (MI)
    …* Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Utilization management, care management, behavioral health ... to subsequently resolve/correct. Required Qualifications * At least 2 years health care experience, preferably in utilization management, care management,… more
    Molina Healthcare (09/28/25)
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  • Care Manager II

    AmeriHealth Caritas (Detroit, MI)
    …of health for medically fragile members with acute, chronic, medically complex, and/or behavioral health conditions and other health needs. Serves as the ... Establishes points of contact to collaborate with identified community, medical, and/or behavioral health teams. + Where applicable, maintain timely, complete,… more
    AmeriHealth Caritas (08/27/25)
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