• Manager , Quality Assurance…

    Humana (Lansing, MI)
    …part of our caring community and help us put health first** Humana is seeking a Manager , Quality Assurance (External LTSS Oversight Team Manager ) who ... assist with monitoring day-to-day operational activities with AAAs. The Manager , Quality Assurance works within...need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid… more
    Humana (10/01/25)
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  • Manager Provider Network Management

    AmeriHealth Caritas (Detroit, MI)
    …of Healthcare Providers and Systems (CAHPS), and National Committee for Quality Assurance (NCQA)/Utilization Review Accreditation Commission (URAC). + ... **Role Overview:** The Manager of Provider Network Management oversees the day-to-day...requirements. + Ensure provider contracts comply with pricing methodologies, Medicaid fee schedules, and internal payment systems. + Resolve… more
    AmeriHealth Caritas (09/16/25)
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  • RN, Manager , Utilization Management…

    Humana (Lansing, MI)
    …Department of Health and Human Services (MDHHS) and National Committee for Quality Assurance (NCQA) guidelines. + Works collaboratively with UM leadership ... caring community and help us put health first** The Manager , Utilization Management Nursing (LTSS Utilization Management Leader) utilizes...need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid… more
    Humana (09/28/25)
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  • Medical Director, Behavioral Health (WA)

    Molina Healthcare (Warren, MI)
    …behavioral health quality compliance with National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS). * Assists ... Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case… more
    Molina Healthcare (10/03/25)
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  • Profee Oncology Senior Complex Coder

    Banner Health (MI)
    …department for clarification/additional information for accurate code assignment. 3. Provides quality assurance for medical records. For all assigned records ... timely and accurate coding in accordance to department specific productivity and quality standards. Codes ICD CM and CPT4 for accurate APC assignment. Addresses… more
    Banner Health (09/05/25)
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  • Sr. AI Business Analyst - Remote

    Prime Therapeutics (Lansing, MI)
    …requestors to resolve questions regarding requested software changes, and participate with Quality Assurance and UAT resources to review related test cases ... resource needs; collaborate with Business Systems Analyst Resource Lead or Resource Manager to determine work assignments within project + Educate and advance… more
    Prime Therapeutics (10/01/25)
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