- Humana (Lansing, MI)
- …a part of our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims ... and preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate… more
- Molina Healthcare (Grand Rapids, MI)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care....experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Molina Healthcare (Warren, MI)
- **JOB DESCRIPTION** **Job Summary** The Medical Director for Specialty Medical Services & Market Performance will provide clinical expertise and support to ... activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. +...Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care.… more
- Molina Healthcare (Sterling Heights, MI)
- …knit proximity ongoing after contract. * In conjunction with Director /Manager, Provider Contracts, negotiates and analyzes, Complex Provider contracts including ... BI. * Targets and recruits additional providers to reduce member access grievances . * Engages targeted contracted providers in renegotiation of rates and/or… more