- Henry Ford Health System (Warren, MI)
- The support specialist is a support role crucial to the centralized Utilization Review team for time sensitive authorization tracking and resolution ... well-being of our team members is our priority. That's why we offer support in the various components of our team's well-being: physical, emotional, social,… more
- Integra Partners (Troy, MI)
- The Medical Policy & Compliance Specialist is responsible for researching, analyzing, and interpreting CMS (Medicare) and state Medicaid guidelines to ensure the ... assist with provider inquiries, identify compliance risks areas, and support process improvement initiatives across the company. Salary: $110,000/Annually The… more
- Trinity Health (Ann Arbor, MI)
- …payment arrangements. Obtains medical authorization or referral forms, if appropriate. Audit authorizations for accuracy and determine if delay/deny policy needs to ... (pre-certifications, third-party authorizations, referrals) and contacts physicians and Case Management/ Utilization Review personnel, as needed. Obtains and verifies the… more
- Vail Resorts (MI)
- …decisions relative to inventory to maximize member reservation fulfillment and gear utilization to help deliver greater profitability. + Support local Rental ... filled (whichever is first). **Job Summary:** In this Inventory Specialist role, you will spend most of your time...trends, you will engage with Operations on maximizing gear utilization , supporting required gear movement, and resolution of the… more
- Trinity Health (Howell, MI)
- …payment arrangements. Obtains medical authorization or referral forms, if appropriate. Audit authorizations for accuracy and determine if delay/deny policy needs to ... (pre-certifications, third-party authorizations, referrals) and contacts physicians and Case Management/ Utilization Review personnel, as needed. Obtains and verifies the… more
- SpartanNash (Wyoming, MI)
- …managing pricing, analyzing usage trends, and optimizing purchasing decisions to support retail pharmacy operations. **Here's what you'll do:** + Generate various ... reports (ie store sales, prescription drug utilization , inventory, etc.) and review with pharmacy procurement team...to maintain confidential information and data. + Ability to audit and review records and processes and provide analytical… more
- Henry Ford Health System (Detroit, MI)
- GENERAL SUMMARY: Under the direction of the Compliance Audit Manager, the Principal Compliance Investigator will oversee compliance auditing and monitoring to assess ... for compliance. + Partner with and provide oversight and support to a variety of partners organizationally across HFH...all levels of the organization. + Writes and reviews audit programs, audit work papers, and … more
- Molina Healthcare (Ann Arbor, MI)
- …following: + Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare ... Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies and… more