- Humana (Lansing, MI)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review of all… more
- Humana (Lansing, MI)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
- Travelers Insurance Company (Lansing, MI)
- …Medical Consortiums and other medical resources as appropriate. Train and evaluate physician and non- physician medical review personnel and activities. ... which can impact claim outcomes. Organize and coordinate Travelers' medical review functions. This includes interpreting Federal and State regulations and medical… more
- Henry Ford Health System (Detroit, MI)
- …obtains action approval from director and division head or chair. + Tracks utilization , lead-time, and all other access related issues. + Presents data regularly to ... practices, policies, and procedures. + Manage, monitor, and track the physician FTE breakdown (ie inpatient vs. outpatient time, research, medical education,… more
- Munson Healthcare (Traverse City, MI)
- …facilitate the progress of completing complex post-acute services + Interface with utilization review specialists to stay current on patient's eligibility for ... service/interpersonal skills at all times. + Maintains working knowledge/experience in utilization management, managed care, and payer issues that may impact the… more
- Tenet Healthcare (Detroit, MI)
- …resolve conflict. Promotes a positive customer relations environment. Coordinates the utilization review function for assigned patients. Performs periodic ... and timely manner, at the most appropriate level of care. Performs continuous review of services to assure patient progress and maintains communication with families… more
- Prime Healthcare (Port Huron, MI)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. Assesses ... Medical Group which offers patient-centered care through primary and specialty care physician practices located throughout the Blue Water Area. Raising the bar for… more
- McLaren Health Care (Flint, MI)
- …or other health care setting. **Preferred:** + One (1) year Managed Care Utilization review experience. + Experience and knowledge of the preauthorization ... at the most appropriate and cost-effective setting. Monitors members' utilization patterns for identification of high-risk and under and...process for medical services. + Physician office experience. + Experience and knowledge of Medicare,… more
- AmeriHealth Caritas (Detroit, MI)
- …Providers and Systems (CAHPS), and National Committee for Quality Assurance (NCQA)/ Utilization Review Accreditation Commission (URAC). + Participate in internal ... & Contracting** + Lead the development and management of hospital and physician networks across current and expansion markets. + Recruit providers and negotiate… more
- Fresenius Medical Center (Muskegon, MI)
- …staff in problem solving. **PHYSICIANS:** + Facilitates the application process for physician privileges and compliance with FMS Medical Staff By-Laws. + Responsible ... for strong Director and physician relationships and facilitating staff relationships with physicians. +...+ Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic,… more