... or Utilization Review Accreditation Commission (URAC) standards. * PGY-1 or PGY-2 Managed Care Pharmacy Residency experience. * Familiarity with Michigan Medicaid MDHHS contract compliance ...
... or Utilization Review Accreditation Commission (URAC) standards. * PGY-1 or PGY-2 Managed Care Pharmacy Residency experience. * Familiarity with Michigan Medicaid MDHHS contract compliance ...
... or Utilization Review Accreditation Commission (URAC) standards. * PGY-1 or PGY-2 Managed Care Pharmacy Residency experience. * Familiarity with Michigan Medicaid MDHHS contract compliance ...
... or Utilization Review Accreditation Commission (URAC) standards. * PGY-1 or PGY-2 Managed Care Pharmacy Residency experience. * Familiarity with Michigan Medicaid MDHHS contract compliance ...
... or Utilization Review Accreditation Commission (URAC) standards. * PGY-1 or PGY-2 Managed Care Pharmacy Residency experience. * Familiarity with Michigan Medicaid MDHHS contract compliance ...
... or Utilization Review Accreditation Commission (URAC) standards. * PGY-1 or PGY-2 Managed Care Pharmacy Residency experience. * Familiarity with Michigan Medicaid MDHHS contract compliance ...
... Utilization Review Accreditation Commission (NCQA/URAC), and analytics teams to ensure alignment on ... Ensures provider contracts are consistent with organizational guidelines, claim payment ...
New
... Utilization Review Accreditation Commission (NCQA/URAC), and analytics teams to ensure alignment on ... Ensures provider contracts are consistent with organizational guidelines, claim payment ...
New
... Utilization Review Accreditation Commission (NCQA/URAC), and analytics teams to ensure alignment on ... Ensures provider contracts are consistent with organizational guidelines, claim payment ...
... Utilization Review Accreditation Commission (NCQA/URAC), and analytics teams to ensure alignment on ... Ensures provider contracts are consistent with organizational guidelines, claim payment ...
... Utilization Review Accreditation Commission (NCQA/URAC), and analytics teams to ensure alignment on ... Ensures provider contracts are consistent with organizational guidelines, claim payment ...
New
... Utilization Review Accreditation Commission (NCQA/URAC), and analytics teams to ensure alignment on ... Ensures provider contracts are consistent with organizational guidelines, claim payment ...
New
... Utilization Review Accreditation Commission (NCQA/URAC), and analytics teams to ensure alignment on ... Ensures provider contracts are consistent with organizational guidelines, claim payment ...
New
... Utilization Review Accreditation Commission (NCQA/URAC), and analytics teams to ensure alignment on ... Ensures provider contracts are consistent with organizational guidelines, claim payment ...
New
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Quick apply
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Quick apply
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Board-Certified Cardiologist
Orchard Lake, MI · On-site
$324K - $366K/yr
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Quick apply
Board-Certified Cardiologist
Orchard Lake, MI · On-site
$324K - $366K/yr
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Director of Utilization Management (PCN 1527)
Troy, MI · On-site
$102K - $128K/yr
... review of service utilization and cost reporting. The Director is involved in quality improvement efforts in compliance with all corporate policies, provider contracts, and state and federal ...
Quick apply
Director of Utilization Management (PCN 1527)
Troy, MI · On-site
$102K - $128K/yr
... review of service utilization and cost reporting. The Director is involved in quality improvement efforts in compliance with all corporate policies, provider contracts, and state and federal ...
MI · On-site
$324K - $366K/yr
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
MI · On-site
$324K - $366K/yr
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
MI · On-site
$324K - $366K/yr
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
MI · On-site
$324K - $366K/yr
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Contract Utilization Review information
What are the key skills and qualifications needed to thrive in contract utilization review?
To thrive in Contract Utilization Review, you need a solid understanding of medical terminology, insurance policies, and contract compliance, often supported by a healthcare-related degree or certification in utilization management. Familiarity with utilization review software, electronic medical records (EMR), and knowledge of regulatory standards such as CMS guidelines is essential. Strong analytical thinking, attention to detail, and effective communication skills are crucial for collaborating with care teams and insurers. These abilities ensure reviews are accurate, contracts are properly administered, and patient care meets organizational and payer requirements.
What does a contract utilization review do?
A typical day in Contract Utilization Review involves reviewing patient medical records, ensuring adherence to payer contracts and regulatory standards, and communicating with healthcare providers to validate medical necessity of services. Professionals in this role often collaborate with clinical staff, case managers, and insurance representatives to resolve discrepancies or authorization issues. The work is detail-oriented and deadline-driven, making organizational skills vital. This dynamic position offers significant opportunities to learn more about healthcare regulations and may serve as a stepping stone toward more advanced roles in healthcare administration or compliance.
What is a contract utilization review?
A Contract Utilization Review job involves analyzing and evaluating the usage of contracts to ensure compliance, cost-effectiveness, and efficiency. Professionals in this role review contract terms, monitor vendor performance, and assess utilization data to optimize contract value. They may work in industries such as healthcare, government, or procurement, ensuring that agreements are being properly executed. The goal is to identify areas for improvement, reduce waste, and enhance operational efficiency.
What are the most commonly searched types of Utilization Review jobs in Michigan?
The most popular types of Utilization Review jobs in Michigan are:
What are popular job titles related to Contract Utilization Review jobs in Michigan?
For Contract Utilization Review jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Contract Utilization Review jobs in Michigan look for?
The top searched job categories for Contract Utilization Review jobs in Michigan are:
What cities in Michigan are hiring for Contract Utilization Review jobs?
Cities in Michigan with the most Contract Utilization Review job openings:
McLaren Health Care rating
6.7
Based on 221 frontline employees who took The Breakroom Quiz
533rd of 887 rated healthcare providers
Job description
McLaren Health Plan (MHP) is a company with a culture of high performance and a mission to help people live healthier and more satisfying lives. We are looking for a Manager, Pharmacy Operations, to join in leading the organization forward.
MHP is a Managed Care Organization dedicated to meeting the health care needs of each member. MHP offers multiple product lines, including individual and family plans, and Medicaid and Medicare plans to Michigan residents for every stage of life. McLaren Health Plan is accredited by the National Committee for Quality Assurance (NCQA).
MHP values the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plan can thrive. As an employee of MHP, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.
Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org
Position Summary:
The Manager of Pharmacy Operations is a licensed clinical leadership position responsible for the strategic oversight and day-to-day management of McLaren Health Plan's pharmacy program across all lines of business (LOB), including Medicaid, Medicare Advantage, and Commercial products. This role serves as a clinical subject matter expert and operational leader, ensuring the delivery of high-quality, cost-effective, and compliant pharmacy services. Reporting to the Director, the Manager position will collaborate closely with medical management, quality, compliance, finance, and external Pharmacy Benefit Manager (PBM) partner to drive pharmacy program excellence.
#LI-KH1
Qualifications:
Required:
- Bachelor's degree in pharmacy, healthcare administration, business, or a related field; or an Associate degree in pharmacy, healthcare administration, business or a related field and two (2) years' related experience.
- Must possess a valid, current, unrestricted Michigan license or certification as either a Certified Pharmacy Technician (CPhT) or Registered Pharmacist (RPh)
- Five (5) years of progressively more responsible pharmacy experience, with experience and knowledge of HMO, PPO, TPA, PHO, and Managed care functions with at least two (2) years' experience with formulary management, drug utilization review, and clinical program development, including at least two (2) years in a supervisory role leading or assisting in all phases of efective supervision (i.e. Recruitment, performance management, training).
- Two (2) years' Experience with NCQA Health Plan Accreditation and/or Utilization Review Accreditation Commission (URAC) standards.
- PGY-1 or PGY-2 Managed Care Pharmacy Residency experience.
- Familiarity with Michigan Medicaid MDHHS contract compliance requirements and CHAMPS system.
- Proficiency with pharmacy claims data, reporting tools, and population health analytics platforms.
- Familiarity with McLaren Health Plan, McLaren Health Care, or McLaren Integrated HMO Group products.
What McLaren Health Care employees say
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About McLaren Port Huron
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
1,001 - 5,000 Employees
Headquarters location
Port Huron, MI, US