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Live In Recovery Audit Jobs in Michigan (NOW HIRING)

Plantemoran

Cybersecurity IT Audit Manager

Southfield, MI

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Performing and/or managing Information Technology(IT) audits and security assessments in various ... in which we live and work.Plante Moran is an Equal Opportunity Employer. Plante Moran maintains a ...

Rehmann

Audit & Assurance - Manager

Traverse City, MI · On-site

  • PTO

Presenting audit findings to client leadership * Providing direction and new challenges to ... Making a difference in the communities where you live and work Your Desired Skills, Experiences ...

THOMSON REUTERS

Senior Sales Executive, Audit

Ann Arbor, MI · Hybrid

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Maintain accurate forecasting and pipeline hygiene in CRM (Salesforce) * Stay current on audit ... We live by our values: Obsess over our Customers, Compete to Win, Challenge (Y)our Thinking, Act ...

Thomson Reuters

Senior Sales Executive, Audit

Ann Arbor, MI · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Maintain accurate forecasting and pipeline hygiene in CRM (Salesforce) * Stay current on audit ... We live by our values: Obsess over our Customers, Compete to Win, Challenge (Y)our Thinking, Act ...

BRAZEWAY

Manufacturing Engineer

Adrian, MI

$65K - $84K/yr

  • Medical

  • Life

  • Retirement

Within a 45-minute commute are opportunities to live on a lake, live in the heart of a vibrant city ... Conduct internal audits and support external audits (e.g., ISO compliance). Review and approve ...

BRAZEWAY

Manufacturing Engineer

Adrian, MI · On-site

$65K - $84K/yr

  • Medical

  • Life

  • Retirement

Within a 45-minute commute are opportunities to live on a lake, live in the heart of a vibrant city ... audits and support external audits (e.g., ISO compliance). • Review and approve production ...

Detroit Recovery Project

Staff Accountant

Detroit, MI · On-site

$60K - $62K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

... in developing a healthy recovery ecosystem for those seeking long-term recovery. Through strong ... audit preparation. The Staff Accountant will collaborate closely with departments across the ...

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Medical Director - Clinical Denial Recovery Unit (CDRU)/Payor Audit

Corporate Services

Detroit, MI • On-site

Full-time

Re-posted 16 days ago

Job description

GENERAL SUMMARY:

Reports to the Chief Utilization Officer (CUO) of Henry Ford Health, responsible for Clinical Denial Recovery Unit (CDRU) operations.  Responsible for strategic and operational leadership and oversight of programs and initiatives including denials management, performance improvement, regulatory, compliance, and risk with an expectation of national top decile performance.  This system role includes physician oversight and clinical input for post-discharge medical necessity denials at all HFHS acute care facilities. 

PRINCIPLE DUTIES AND RESPONSIBILITIES:

1.    Oversee a comprehensive value-driven centralized denial management process.

2.    In collaboration with executive and administrative partners, provide clinical expertise to CDRU, Payor Audit, hospital UM teams, system IPAS, managed care contracting, and legal.

3.    Participate as a clinical expert in payer negotiations and escalations, Accounts Receivable Reconciliation Group (AARGs) and Medical Director Meetings (MDMs), and during Administrative Law Judge (ALJ) hearings for denied cases.

4.    Standardize and oversee a comprehensive reliability-driven process for status determination in concert with site level physician advisors.

5.    Prepare and analyze denial metrics and make recommendations for process improvements.

6.    Provide feedback to system IPAS regarding denial trends, opportunities for improvement, and payor practices.

7.    Report out metrics and initiatives at Medical Executive and Executive Leadership meetings as requested.

8.    Assist the manager of CDRU, UM Director, and Director of Payor Audit with preparation of case escalations for payer negotiations.

9.    Assist the CDRU RN staff with medical necessity appeals for complex medical cases.

10. Maintain a working knowledge of applicable Federal, State and local laws and regulations, initiatives, and expectations as set by payers and CMS.

11. Collaborate with accountable leaders to develop processes that ensure consistent feedback for all involved care providers regarding specific denial mitigation strategies and performance results. 

#PR

EDUCATION/EXPERIENCE REQUIRED:

      Graduate of an accredited medical school, completion of a three (3) year U.S. residency program, and board certified in their specialty.

      Minimum seven (7) years of clinical practice as a physician.

      Previous performance-based leadership experience preferred.

#PR

Additional Information
  • Organization: Corporate Services
  • Department: Internal Phys Advisor Svcs
  • Shift: Day Job
  • Union Code: Not Applicable

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