- Humana (Lansing, MI)
- …**Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other ... experience in a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health...to innovate **Additional Information** Reports to the Lead Medical Director - North Central Medicaid Markets. The… more
- Molina Healthcare (Sterling Heights, MI)
- …policy/procedure development, provider contracting experience. + Experience with NCQA, HEDIS, Medicaid , Medicare and Pharmacy benefit management, Group/IPA ... medical director , and quality improvement staff. + Facilitates conformance to Medicare , Medicaid , NCQA and other regulatory requirements. + Reviews quality… more
- Molina Healthcare (Detroit, MI)
- …with clinical leadership and quality improvement teams. * Facilitates conformance to Medicare , Medicaid , NCQA and other regulatory requirements. * Reviews ... providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management. * Assumes leadership… more
- AmeriHealth Caritas (Detroit, MI)
- …psychosocial needs. This role ensures that care is delivered by Centers for Medicare & Medicaid Services (CMS), state, and organizational guidelines, within the ... individuals with chronic conditions or disabilities. + Strong understanding of Medicare - Medicaid Plan Long-Term Services and Supports (MMP LTSS) programs.… more
- Prime Therapeutics (Lansing, MI)
- …pharmaceutical manufacturers, with specific emphasis on Medicare Part D and Managed Medicaid . The Sr Director , Pharm Trade Relations leads a team of ... every decision we make. **Job Posting Title** Sr Dir Pharmacy Trade Relations - Remote **Job Description** The Sr...the oversight of Trade formulary strategies for Commercial, Exchange, Medicare Part D and/or Medicaid template formularies,… more
- Molina Healthcare (Detroit, MI)
- …policy/procedure development, provider contracting experience. + Experience with NCQA, HEDIS, Medicaid , Medicare and Pharmacy benefit management, Group/IPA ... medical director , and quality improvement staff. + Facilitates conformance to Medicare , Medicaid , NCQA and other regulatory requirements. + Reviews quality… more
- Gentiva (West Branch, MI)
- …Hospice Medical Director Certification Board certification preferred. + Current Medicare Provider Enrollment (PECOS) and Medicaid certification if required. ... through Compassionate Hospice Leadership.** We are seeking a dedicated Hospice Medical Director to join our leadership team and provide expert clinical oversight to… more
- Molina Healthcare (Ann Arbor, MI)
- …policy/procedure development, provider contracting experience. * Experience with NCQA, HEDIS, Medicaid , Medicare and Pharmacy benefit management, Group/IPA ... EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in...unrestricted State (TX) Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer… more
- Grifols Shared Services North America, Inc (Detroit, MI)
- …coding, and coverage-related responsibilities for Medicare Part B, Centers for Medicare and Medicaid (CMS) Healthcare Common Procedure Coding System (HCPCS), ... and services in more than 110 countries and regions. The Associate Director , Value Access Marketing & Reimbursement is responsible for developing and executing… more
- Henry Ford Health System (Detroit, MI)
- …as quarterly and year-end financial audits. + Maintain deep expertise in Medicare , Blue Cross, Medicaid , and other reimbursement regulations, ensuring ... premier academic and integrated health systems, is seeking a Director of Corporate Reimbursement to lead critical financial functions...a full suite of home health offerings, virtual care, pharmacy , eye care and other health care retail. With… more
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