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Conditional Employment Requirements: Employment offers for this position will be contingent upon the results of a background verification, and credentialing procedure consisting of: Michigan State Police clearance check, undergo and pass a Central Registry Screening, verification of a professional license, Medicaid/Medicare verification, verification of an acceptable driving record, educational background check, and verification of an acceptable work history.
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Possession of an appropriate State of Michigan credential is required (LMSW, LLMSW, LLPC, LPC, LLP, FLP, etc.) Responsibilities: Under the supervision of the Crisis Services Coordinator, Adult Mental Health Services, interviews individuals (both walk-in and telephone) who may need crisis intervention and/or voluntary or involuntary admission to a local or state hospital.
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The McLaren system includes 13 hospitals in Michigan, ambulatory surgery centers, imaging centers, a primary and specialty care physician network, commercial and Medicaid HMOs, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company.
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Registered Nurse - Medical Surgical/Emergency Room - Weekend Only. McLaren Health Care is a fully integrated health network committed to quality, evidence-based patient care with locations in Michigan and Indiana.
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Extensive experience in healthcare contracting, with a critical understanding of PBMs, National Health Plans, Medicare Part D/B, GPOs, VA/DoD, Medicaid, and the evolving market landscape. Minimum of 12 years of pharmaceutical industry experience, with significant expertise in at least two of the following areas: Channel Strategy, Finance, Pharmacy, Pricing, Trade, or Market Access.
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Experience Medicare/Medicaid populations - MCG experience - Managed care experience - UM Certification - MedCompass - 1+ year(s) of inpatient utilization experience *Education. This Utilization Management (UM) Nurse Consultant role is fully remote and employee can live in any state.
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Note: The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for Disease Control and Prevention (CDC), require COVID-19 vaccinations for all Medicare and Medicaid certified providers.
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This job will deliver value to the Health Plan and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and/or Affordable Care Act (ACA) using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, and Centers for Medicare and Medicaid Services (CMS) coding guidelines.
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This position reports to the Senior Director, Market Access and is responsible for establishing and leveraging credible relationships within all assigned accounts in Mid Atlantic (MD, VA, DE, DC) which will include the following account types; regional payers, regional specialty pharmacies, regional PBMs, select IDNs and state Medicaid agencies to achieve and maintain open and appropriate access for all Sanofi Specialty’s specialty products.
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Assist consumers with the filing, pursuit, and resolution of complaints and appeals through existing processes, including internal reviews conducted by health benefits plans, grievance and appeals processes for the HealthCare Alliance, fair hearings available to Medicaid consumers, external reviews before independent review organizations, and any other administrative appeals available under District or federal law.
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Michigan State Police clearance check, verification of professional license, Medicaid/Medicare verification, Board Certification, Controlled Substance license verification, National Practitioner Databank verification, educational background check and verification of an acceptable work history.
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MPCA HealthCorps Program engages AmeriCorps members in individualized outreach attempts using a variety of methods (phone calls, letters, texting, and face-to-face connections (as feasible/appropriate) to connect patients/Medicaid beneficiaries with a primary health care provider at Health Centers.
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Top Skills: 5 years of experience as an IT Project Manager working on RFP’s (request for proposals)Experience as a Business Analysis Expertise in Business Requirements CollectionExperience working with third party vendorsNice to have: Experience with Medicaid ApplicationsThis position provides oversight, leadership, accountability, and project management functions for multiple small or medium sized projects at the same time or for a single large project.
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Knowledge of terminally ill patients and their families along with understanding of hospice concept; knowledge of roles of all disciplines providing hospice services; excellent patient assessment skills; good oral and written communication; thorough knowledge of managed care principles, regulatory guidelines (i.e., Medicare, Medicaid, and human resource) management principles.
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Review the Medicare, Managed Care, Medicare Advantage and Medicaid UB, CHAMPS, WebDenis. + Process Medicaid applications. Review the Medicare, Managed Care, Medicare Advantage and Medicaid UB, CHAMPS, WebDenis.
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medicaid job in Lansing, MI
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