Molina Healthcare jobs in Detroit, MI

The Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. The SIU Investigator is responsible for reviewing and analyzing information to draw conclusions on allegations of FWA and/or may determine appropriateness of care. The SIU Investigator is also responsible for recognizing and adhering to national and local coding and billing guidelines in order to maintain coding accuracy and excellence. The position also entails producing audit reports for internal and external review. The position may also work with other internal departments, including Compliance, Corporate Legal Counsel, and Medical Officers in order to achieve and maintain appropriate anti-fraud oversight. **Job Duties** + Responsible for developing leads presented to the SIU to assess and determine whether potential fraud, waste, or abuse is corroborated by evidence. + Conducts both preliminary assessments of FWA allegations, and end to end full investigations, including but not limited to witness interviews, background checks, data analytics to identify outlier billing behavior, contract and program regulation research, provider and member education, findings identification and communications development, and recommendations and preparation of overpayment identifications and closure of investigative cases. + Completes investigations within the mandated period of time required by either state and/or federal contracts and/or regulations. + Conducts both on-site and desk top investigations. + Conducts low to medium, and extensive investigations, including reviews of medical records and data analysis, and makes determinations as to whether the investigation and/or audit identified potential fraud, waste, or abuse. + Coordinates with various internal customers (e.g., Provider Services, Contracting and Credentialing, Healthcare Services, Member Services, Claims) to gather documentation pertinent to investigations. + Detects potential health care fraud, waste, and abuse through the identification of aberrant coding and/or billing patterns through utilization review. + Prepares appropriate FWA referrals to regulatory agencies and law enforcement. + Documents appropriately all case related information in the case management system in an accurate manner, including storage of case documentation following SIU related requirements. Prepares detailed preliminary and extensive investigation referrals to state and/or federal regulatory and/or law enforcement agencies when potential fraud, waste, or abuse is identified as required by regulatory and/or contract requirements. + Renders provider education on appropriate practices (e.g., coding) as appropriate based on national or local guidelines, contractual, and/or regulatory requirements. + Interacts with regulatory and/or law enforcement agencies regarding case investigations. + Prepares audit results letters to providers when overpayments are identified. + Works may be remote, in office, and on-site travel within the state of New York as needed. + Ensures compliance with applicable contractual requirements, and federal and state regulations. + Complies with SIU Policies as and procedures as well as goals set by SIU leadership. + Supports SIU in arbitrations, legal procedures, and settlements. + Actively participates in MFCU meetings and roundtables on FWA case development and referral **JOB QUALIFICATIONS** **Required Education** Bachelors degree or Associate's Degree, in criminal justice or equivalent combination of education and experience **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** + 1-3 years of experience, unless otherwise required by state contract + Proven investigatory skill; ability to organize, analyze, and effectively determine risk with corresponding solutions; ability to remain objective and separate facts from opinions. + Knowledge of investigative and law enforcement procedures with emphasis on fraud investigations. + Knowledge of Managed Care and the Medicaid and Medicare programs as well as Marketplace. + Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems. + Understanding of datamining and use of data analytics to detect fraud, waste, and abuse. + Proven ability to research and interpret regulatory requirements. + Effective interpersonal skills and customer service focus; ability to interact with individuals at all levels. + Excellent oral and written communication skills; presentation skills with ability to create and deliver training, informational and other types of programs. + Advanced skills in Microsoft Office (Word, Excel, PowerPoint, Outlook), SharePoint and Intra/Internet as well as proficiency with incorporating/merging documents from various applications. + Strong logical, analytical, critical thinking and problem-solving skills. + Initiative, excellent follow-through, persistence in locating and securing needed information. + Fundamental understanding of audits and corrective actions. + Ability to multi-task and operate effectively across geographic and functional boundaries. + Detail-oriented, self-motivated, able to meet tight deadlines. + Ability to develop realistic, motivating goals and objectives, track progress and adapt to changing priorities. + Energetic and forward thinking with high ethical standards and a professional image. + Collaborative and team-oriented **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION** : + Valid driver's license required. **PREFERRED EXPERIENCE** : At least 5 years of experience in FWA or related work. **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION** : + Health Care Anti-Fraud Associate (HCAFA). + Accredited Health Care Fraud Investigator (AHFI). + Certified Fraud Examiner (CFE). To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.82 - $51.06 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Molina Medicare Stars Program Manager functions oversees, plans and implements new and existing health care quality improvement initiatives and education programs. Responsible for Medicare Stars projects and programs involving enterprise, department or cross-functional teams of subject matter experts, delivering impactful initiatives through the design process to completion and outcomes measurement. Monitors the programs and initiatives from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs and monitors system analysis and program staff. These positions' primary focus is project/program management for Stars Program and Quality Improvement activities. **Job Duties** + Collaborates with teams & health plans impacted by Medicare Quality Improvement programs involving enterprise, department or cross-functional teams of subject matter experts, delivering products through the design process to completion. + Supports Stars program execution and governance needs to communicate, measure outcomes and develop initiatives to improve Star Ratings + Plans and directs schedules Program initiatives, as well as project budgets. + Monitors the project from inception through delivery and outcomes measurement. + May engage and oversee the work of external vendors. + Focuses on process improvement, organizational change management, program management and other processes relative to the Medicare Stars Program + Leads and manages team in planning and executing Star Ratings strategies & programs. + Serves as the Medicare Stars subject matter expert in the functional area and leads programs to meet critical needs. + Communicates and collaborates with health plans to analyze and transform needs and goals into functional requirements. + Delivers the appropriate artifacts as needed. + Works with Enterprise and Health Plan l leaders within the business to provide recommendations on opportunities for process improvements. + Monitors and tracks key performance indicators, programs and initiatives to reflect the value and effectiveness of Stars and Quality improvement programs + Creates business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations. + Generate and distribute standard reports on schedule **Job Qualifications** **REQUIRED EDUCATION** : Bachelor's Degree or equivalent combination of education and experience. **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : - 3-5 years of Medicare Stars Program and Project management experience. + Demonstrated knowledge of and experience with Star Ratings & Quality Improvement programs - Operational Process Improvement experience. - Medicare experience. - Experience with Microsoft Project and Visio. - Excellent presentation and communication skills. - Experience partnering with different levels of leadership across the organization. **PREFERRED EDUCATION** : Graduate Degree or equivalent combination of education and experience. **PREFERRED EXPERIENCE** : - 5-7 years of Medicare Stars Program and/or Project management experience. - Managed Care experience. - Experience working in a cross functional highly matrixed organization. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $171,058 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

DMC Harper University Hospital has distinguished itself in surgery and medicine and is known for its clinical expertise and innovative research. A specialty referral hospital, Harper has established Centers of Excellence in neurosciences, bariatric surgery, vascular services, multidisciplinary cardiovascular services, hypertension, stroke prevention and heart failure. Summary Description Under direct supervision and according to established policies and procedures, performs a variety of duties in the OR and related areas to assist the surgical team and surgeon. Performs the duties of a surgical technician and provides direct assistance to the surgeon as a surgical technologist first-assistant during surgeries. Facilitates surgical procedures by providing the surgeon with necessary surgical instruments, supplies and/or equipment. PRINCIPAL DUTIES AND RESPONSIBILITIES 1. Scrubs on all types of operating procedures; handles surgical instruments, sutures & sponges; anticipates the needs of the surgeon, assisting as required. Maintains strict aseptic technique, identifying and correcting any breaks in technique. Maintains an accurate count of sponges, sharps and instruments; assumes joint responsibility with the circulating nurse for ensuring that all are accounted for during and after the operation. Observes patient's condition while in the OR; reports any changes to the staff nurse and/or anesthesia. 2. Prepares for scheduled operative procedures, ensuring that necessary equipment, instruments and supplies are available and ready for use. 3. Maintains a clean and safe OR environment; cleans rooms and sterilizes equipment. Restocks OR with standard supplies and assists in updating surgical instrument sets. Maintains power equipment and specialty instrumentation within assigned specialty areas. 4. Assists in the transportation of patients to and from the OR; verifies patient identity; assists with lifting and positioning of patient for surgical procedures. 5. Provides direct assistance to the surgeon during surgery as first-assistant. Handles tissue; provides exposure, sutures, uses instruments and provides hemostasis under the direct supervision of the surgeon. Facilitates surgical procedures by providing the surgeon with necessary surgical instruments, supplies and/or equipment. 6. Participates in the orientation of new surgical technician personnel. 7. May assist as second circulator under the direction of a registered nurse. Prepares materials to be presented in dept in-service education programs as assigned. Assists in the trial and evaluation of new surgical products. Provides input to managers in developing new policies and procedures for the department. Participates on committees as assigned.* 8. Performs other related duties as assigned.. Qualifications: Minimum Qualifications 1. High school diploma or equivalent. 2. Certification as a surgical technologist by an accredited certifying agency recognized by the Association of Surgical Technologists. 3. Graduation from an accredited First Assistant program. 4. Surgical First Assistant certification. 5. Certified in CPR. 6. One to two years experience as a surgical technologist in an operating room setting. Skills Required 1. Interpersonal skills necessary to work effectively and efficiently with nursing and medical staff in stressful and emergency situations. 2. Physical stamina for prolonged standing, walking, and lifting. 3. Manual dexterity and visual acuity including ability to see fine discriminate detail, to pass instruments, cut sutures, hold retractors, etc. 4. Knowledge of medical terminology and anatomy required. Job: Surgery/Surgical Primary Location: Detroit, Michigan Facility: DMC Harper University/Hutzel Women's Hospital Job Type: Full Time Shift Type: Day ********** Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: *****************************

DMC Sinai-Grace Hospital is committed to providing exceptional patient care in a supportive and collaborative environment. As a member of our team, you will have the opportunity to work with advanced technology and be part of a healthcare community dedicated to making a positive impact on the lives of our patients. Benefits Statement At Tenet Healthcare, we understand that our greatest asset is our dedicated team of professionals. That's why we offer more than a job - we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include: * Medical, dental, vision, and life insurance * 401(k) retirement savings plan with employer match * Generous paid time off (PTO) * Career development and continuing education opportunities * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance. Note: Eligibility for benefits may vary by location and is determined by employment status Job Summary Under general supervision, directs and coordinates all aspects of assigned registry including data collection. data submission, quality report issues, outcome report review and analysis Acts as administrative contact to the registry or projects assigned responding to all requests from the registry for information to include: clinical interpretation of data element definitions; data submission process; data quality and cleaning; data submission to meet regulatory or stakeholder requirements, review of comparative institutional reports and use of outcome reports for quality measurement and improvement. Interviews patients and/or accesses the patients medical records and abstracts required clinical data. * Responsible for the timely and accurate collection of data and entry/upload into the web-based program, as applicable. * Participates in project training sessions and meetings, and maintains regular contact with the registry staff, assigned projects physician champions, nurses, and other clinicians and administrators. Serves as a source of clinical expertise in measurement of outcomes of care. * Promotes consistent application, effective processes and accountability for the clinical improvement program. * Establishes standards and procedures for projects such as tracking, reporting, recordkeeping and documentation; monitors progress on key quality initiatives and indicators, leading towards achievement of department and organizational goals. * Keeps appropriate parties apprised of overall progress and monitors project results for significant deviations; proposes actions to ensure that timelines and deliverables are met; reviews project deliverables to ensure they meet standards and objectives. * Contributes to the development of policies and procedures related to the clinical improvement program. Based on clinical knowledge of and experience in the delivery of patient care, consistent with Registered Nurse licensure, compiles, analyzes, interprets, and evaluates clinical and quality data collected as part of an integrated system-wide program of clinical improvement. * Identifies opportunities for clinical improvement and involves the appropriate personnel. * Facilitates and/or leads clinical improvement team efforts. Conducts or facilitates education of medical and hospital staff regarding continuous improvement methodology, tools and measurement. * Assists clinicians in understanding measurement for improvement of practice. Participates in the ongoing development of clinical improvement and measurement of its effectiveness. * May provide leadership to the Data Analysts in the Quality & Safety Department. Qualifications: Minimum Qualifications: 1. Graduation from an accredited school of nursing. Bachelors degree in Nursing (BSN) preferred. 2. Licensed to practice as a Registered Nurse (RN) in the state of Michigan. 3. Three years of progressively more responsible clinical and/or quality improvement/process improvement experience, including at least one to two years of experience in health care quality management and the application of continuous improvement methodologies, tools, standards, and guidelines. Facility Description DMC Sinai-Grace Hospital is DMC's largest hospital, offering a comprehensive heart center, cancer care, gerontology, emergency medicine, obstetrics/gynecology and cosmetic services. Sinai-Grace's joint replacement program features a revolutionary minimally invasive knee and hip replacement surgery that attracts patients from all over the country. Sinai-Grace operates more than 21 outpatient care sites and ambulatory surgery centers throughout Wayne and Oakland Counties and is one of 10 hospitals in the nation to be awarded a Robert Wood Johnson Foundation grant to help set the standards of cardiac care for hospitals and physicians throughout the nation. EEO Statement Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations Job: Case Management/Home Health Primary Location: Detroit, Michigan Facility: DMC Sinai-Grace Hospital Job Type: Full Time Shift Type: Day ********** Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: *****************************

Be the heart of compassionate care in a patient care support role with us! In this vital role, you'll provide essential assistance and comfort to patients, ensuring they receive the best possible experience during their healthcare journey. If you're dedicated, empathetic, and ready to make a positive impact on patients' lives, we encourage you to apply today and become a crucial part of our caring team! Benefit Statement At Tenet Healthcare, we understand that our greatest asset is our dedicated team of professionals. That's why we offer more than a job - we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include: * Medical, dental, vision, and life insurance * 401(k) retirement savings plan with employer match * Generous paid time off (PTO) * Career development and continuing education opportunities * Health savings accounts, healthcare C dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder C childcare, auto C home insurance. Note: Eligibility for benefits may vary by location and is determined by employment status Job Summary Under direct supervision, and according to established procedures, observes and monitors assigned patient(s) behavior. Provides safety interventions and basic self care needs as needed while providing attention to specific patients behavioral needs. Accompanies patient(s) for clinical studies, documents pertinent data for observations and notifies appropriate nursing personnel when necessary. Qualifications: 1. High school diploma or equivalent. 2. Completion of a formal CPR course desirable. Facility Description Children'sHospitalofMichiganisaninternationalleaderinpediatricandadolescent medicine.Surgicalservicesincludegeneral,thoracic,reconstructiveand cardiovascular.Imagingtechnologydesignedspecificallyforchildrenprovides advanced diagnostic services including Positron Emission Tomography (PET) and MRI.TheChildren'sHospitalofMichiganEmergencyDepartmentisaverifiedLevel1 PediatricTraumaCenteranddedicatedpediatricburncenter.Expertsinpediatric criticalcare,rehabilitation,andneonatalandperinatalmedicineprovidecareforthousandsofchildreneveryyearat Children'sHospitalofMichigan,Children'sHospitalofMichigan-Troyandsixambulatorysites. EEO Statement Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations Job: Nursing Assistants and PCA Primary Location: Detroit, Michigan Facility: DMC Children's Hospital of Michigan Job Type: PRN Shift Type: Night Shift Begin: 7:00 PMShift End: 7:30 AM ********** Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: *****************************

Provides support for Molina Healthcare's Protection Services Operations Center (PSOC) by conducting daily investigations activities and ensuring enterprise-wide compliance. Reporting to the Manager, Investigations, this role supports employees, handles incident response, and escalates cases involving Molina facilities or interests as needed. Collaborates closely with PSOC partners, Human Resources, Legal, and other stakeholders to support both routine and complex investigations and helps develop tools and processes that meet evolving business needs. **Job Duties** + Engages in high-stress situations to ensure incident response, threat mitigation, and after-care support for involved workforce members and/or company facilities. + Rapidly responds (in a remote environment) to workforce members involved in workplace violence incidents, threat events, and distressed situations. + With minimal oversight, independently leads or provides support to investigations including: + Collects physical or digital evidence and performs detailed analysis + Conducts and accurately documents interviews + Creates, updates and maintains case management records and systems + Prepares comprehensive, timely, and detailed professional incident reports on all inquiries regarding potential and/or actual investigative matters, including presentations on research findings and necessary recommendations. + Establishes, maintains and promotes successful relationships with law enforcement agencies in all jurisdictions with Molina business/employee interests. + Conducts comprehensive Open-Source Intelligence (OSINT) supporting investigative or threat management initiatives. + Supports Threat Intelligence to include conducting employee safety assessments during situational or environmental responses. + Develops and conducts employee awareness training in security focused areas of responsibility. + May be required to work outside of normal business hours (nights, evenings, and weekends) if responding to emergent investigations or employee welfare concerns. + Coordinates dispatch security personnel to respond to incidents. Coordinates and issues alerts (i.e., BOLO) + Other duties as assigned by management **Job Qualifications** **Required Qualifications:** + At least 2 years of corporate business experience in physical security, investigations, or law enforcement, or equivalent combination of relevant education and experience. + Experience in investigative interviewing techniques. + Exceptional written communication, interpersonal, analytical, and research skills with strong case management expertise. + Naturally curious and enjoys learning new things. + Ability to engage in several tasks at once. + Self-motivated and results oriented. + A problem solver and an analytical thinker. + Superb organizational skills and the ability to delegate effectively to meet delivery targets. + Ability to interact concisely/accurately and positively with leadership and colleagues + Action oriented and driven to achieve results in a positive manner, displaying ethical behavior and integrity. + Strong grasp and hands-on experience in physical security. + Situational awareness and responding to incidents involving employee and property threats. + Experience with creation of metrics, reporting and analysis. + Familiarity with best practices and standards and experience with industry standard tools and concepts. **Preferred Qualifications:** + Experience in an operations center preferred To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.82 - $51.06 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

DMC University Laboratories (DMCUL)is a regional, integrated laboratory system providing services to the eight hospitals of Detroit Medical Center. DMC University Laboratories evolved in 1993 and is comprised of Core Laboratories, Specialty Laboratories, two rapid response hospital laboratories, Centralized Stat Lab, Centralized Blood Bank Lab, and full service outreach infrastructure which includes patient service centers, remote ambulatory laboratories, marketing staff, courier system and billing department. The DMC University Laboratories service area covers the entire Southeast Michigan market, and is growing at a rapid pace with the following outstanding features: Test menu of over 1,000 tests, which includes high end specialty tests. Less than 1% of our tests are sent to outside reference laboratories. Provide reference laboratory services to many of the other healthcare systems in Southeastern Michigan and several out of state facilities. Job Summary In collaboration with medical directors and managers, oversees and coordinates activities of the blood bank functions at all DMCUL sites to ensure quality, timely and efficient laboratory service. Develops system-wide policies and procedures in alignment with hospital and DMCUL goals and objectives. Communicates and involves appropriate personnel at all sites to ensure efficient patient care. Delegates daily operations activities to group leaders or designated site personnel. Monitors activities for and ensures compliance with laws, government regulations, JCAHO requirements and DMC policies. As directed, implements external and internal audit recommendations. Ensures hospital departments achieve objectives for diversity of their suppliers. Qualifications: 1. Bachelors degree in Medical Technology or related science. 2. Three to five years progressively more responsible laboratory experience or three to five years supervisory experience in a clinical laboratory. 3. Registered as a Technologist with the American Society of Clinical Pathologists, National Certifying Agency or equivalent. Job: Managers and Directors Primary Location: Detroit, Michigan Facility: DMC University Laboratories, Inc. Job Type: Full Time Shift Type: Day Shift Begin: 8:00 AMShift End: 4:30 PM ********** Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: *****************************

Provides entry level support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** - Enters denials and requests for appeals into information system and prepares documentation for further review. - Researches claims issues utilizing systems and other available resources. - Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. - Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research. - Determines appropriate language for letters and prepares responses to member appeals and grievances. - Elevates appropriate appeals to the next level for review. - Generates and mails denial letters. - Provides support for interdepartmental issues to help coordinate problem-solving in an efficient and timely manner. - Creates and/or maintains appeals and grievances related statistics and reporting. - Collaborates with provider and member services to resolve balance bill issues and other member/provider complaints. **Required Qualifications** - At least 1 year of experience in claims, and/or 1 year of customer/provider service experience in a health care setting, or equivalent combination of relevant education and experience. - Customer service experience. - Organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting experience. - Completion of a health care related vocational program (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $34.88 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

1. One year of college study in behavioral health or equivalent combination of education and experience in an adult mental health setting AND one year of related clinical experience working with mentally ill patients; OR Associates degree in psychology, social work or a human service discipline. 2. Successful completion of annual recipient rights training, physical management in-service and demonstration, maintains active CPR certification. DMC Detroit Receiving Hospital, Michigan's first Level I Trauma Center, helped pioneer the evolution of emergency medicine and currently has one of the busiest and most well-equipped emergency departments anywhere. The first and largest verified burn center in the state is at Receiving, and it is one of only 43 in the nation. Receiving also offers the state's leading 24/7 hyperbaric oxygen program, Metro Detroit's first certified primary stroke center, and the nationally recognized and accredited DMC Rosa Parks Geriatric Center of Excellence. Job Summary Under the supervision of a registered nurse and in collaboration with other members of a multidisciplinary team provides treatment to patients with mental illness. 1. Provides one-to-one interaction with patients. 2. Assists in educational sessions, facilitates task oriented sessions; e.g. Community Meeting. 3. Assists with the patient intake, admission and discharge processes including but not limited to collection of objective data and patients unit orientation. 4. Performs patient, body and property searches, and secures patient property. 5. Participates in patient care conferences and treatment-planning meetings as requested. Observe patients at risk for dangerous behavior (suicidal, self mutilation or aggression towards others). Performs and documents patient and environmental rounds. 6. Obtains vital signs, performs specimen collection (e.g. blood draws, urine collection), diagnostic testing, (e.g. ECG, breathalyzer) and assists with physical examinations as needed. 7. Assists patients with activities of daily living e.g. eating, dressing, bathing and laundry. 8. Monitors and documents patient observations, 1\:1 interactions, intervention/actions taken, and the patients response to interventions provided by the Mental Health Technician. 9. Completes court petitions, accompanies patients to court and testifies to substantiate the need for court ordered treatment. Communicates status of court activity to professional staff. 10. Assists professional staff with restraint and seclusion as needed. 11. Performs routine clerical functions e.g. answering phones, and computer input and retrieval of information, ordering and stocking unit equipment and supplies, generating and distributing reports, updating unit census and other informational boards. 12. Ensures that patient care equipment is clean and in good working order. 13. Promotes guest relations. Anticipates and responds to needs of others. Provides assistance in a quick and courteous manner. 14. Treats others with care and respect while maintaining privacy, confidentiality and dignity. 15. Maintains a professional appearance and a clean, safe environment. 16. Performs other related duties as assigned by management. JOIN OUR TEAM QUALITY CARE DELIVERED BY COMPASSIONATE PEOPLE We know it takes a special person to work in healthcare, and we are committed to providing our people with an enriching and rewarding environment. We deliver the resources, tools and support our employees need to serve our patients and customers in the best way possible - so we can create happier, healthier communities. COMMITTED TO DIVERSITY AND INCLUSION At Tenet, we believe in a diverse and inclusive environment, one that is grounded in our dedication to the health and well-being of all people. Respecting, nurturing and encouraging diversity of thought, background and experience contribute to positive work environments that result in exceptional patient care. We embrace diversity because it's our culture, and because it's the right thing to do.

MICHIGAN GROUP - Detroit Market The Detroit Medical Center is one the largest academic medical centers in the United States, with a long and rich history of medical education, providing training in medical education for more than 100 years. As the nation shifted to more rigorous oversight of physician training, the DMC continued to be a leader in accredited programs in medical education beginning with the Ophthalmology Residency Program's accreditation in 1951, Pathology in 1953, Internal Medicine in 1956, Neurology in 1958. The DMC currently sponsors 80 programs, 72 are currently accredited by Accreditation Council for Graduate Medical Education (ACGME). This includes 10 programs under the Children's Hospital of Michigan. Six of these programs are accredited by other boards. In total, DMC trains over 1000 physicians each year. The DMC maintains Academic affiliations with Michigan State University's College of Osteopathic Medicine, Meharry Medical College and Wayne State University's School of Medicine. The faculty provides the majority of medical student, resident and fellow training at DMC hospitals. The Detroit Medical Center graduates outstanding physicians with advanced training in many specialties including Emergency Medicine, Surgery, Cardiology, Obstetrics and Gynecology, Neurology, Internal Medicine, Pathology, Pediatrics, Radiology and many more. The Chief Human Resources Officer will have direct oversight of the following hospitals: DMC Detroit Receiving Hospital, Michigan's first Level I Trauma Center, has played a pioneer role in the evolution of emergency medicine. Detroit Receiving hosts one of the busiest and most well-equipped emergency departments in southeast Michigan. The oldest and largest verified Level I Burn Center in the state is at Detroit Receiving, and is one of only 43 in the country. This hospital also boasts the state's leading hyperbaric oxygen treatment program, Metro Detroit's first certified primary stroke center, and the nationally recognized Rosa Parks Geriatric Center. Detroit Receiving offers expertise in emergency medicine, complex trauma, critical care, orthopedics, neurosciences, nephrology, pulmonology, diabetes, geriatrics and urology. DMC Harper-Hutzel Hospital has distinguished itself in surgery and medicine and is known for its clinical expertise, innovative research and advanced education. Harper-Hutzel has established Centers of Excellence in neurosciences, bariatric surgery, vascular services, multidisciplinary cardiovascular services, hypertension, stroke prevention and heart failure. Harper-Hutzel is home to the revolutionary Cardio Team One, the new standard of excellence in heart care and is nationally recognized for cutting-edge research in high-risk obstetrics, infertility, reproductive genetics, neonatology, maternal fetal medicine, midwifery, gynecology, urogynecology, menopause, permanent birth control and alternatives to hysterectomy. Harper-Hutzel is a hospital with a rich history of over 143 years as Michigan's first and only hospital for women, and patients benefit from our commitment to research and education. POSITION SUMMARY: The Hospital Chief Human Resources Officer serves the hospital and group leadership team as strategic advisor providing high-quality consultancy on a diverse set of strategic and operational HR issues; representing specific hospital or market needs; ensuring implementation and application of agreed upon HR processes, systems, policies and programs; leads escalation and resolution of employee relation matters; lead HR functional liaison to a specific hospital or market accountable to attract, develop and retain key talent. The Hospital CHRO serves as the key liaison to "broker" the HR service delivery model ensuring appropriate support of human resource services and solutions are provided in areas such as talent management, total rewards, talent acquisition and deployment, learning, employee relations, organization design and restructuring. He/she is accountable to ensure oversight and governance of group and hospitals HR processes, systems, and policies. FUNCTIONAL EXPECTATIONS & REQUIREMENTS: * Consults with business leaders on critical capability and capacity gaps, short- and long-term talent needs, compensation, organization effectiveness and employee development requirements and labor management strategies. * Partners with Hospital Operations CHRO and Tenet CoEs leaders to proactively identify and implement strategic solutions and interventions across all functional areas ensuring SLA and KPI targets are met. * Partners with external HR groups/societies to stay abreast of key industry trends and best practices. * Partners with other senior HR leaders to ensure the successful implementation and constant evolution of the HR service delivery model. ESSENTIAL FUNCTIONS OF THE ROLE: * Acts as a point of contact to the business for all HR related services and solutions. * Plays an active business partner role in strategic meetings (budget process, strategic planning, etc.) and translates business strategies into HR initiatives. * Manages labor and productivity initiatives and actions to deliver cost improvement in areas such as overtime, premium labor, headcount efficiency and contract labor. * Acts as a catalyst to ensure the acquisition, development and performance of leading talent and partners with members of HR service delivery model to ensure sourcing, staffing, and onboarding needs are met. * Builds the capability of direct reports and that of the broader HR team, identifying and supporting them through their own development and towards their career go * Drives the use of data analytics, and external/internal insights to design innovative HR solutions based on short- and long-term business needs. * Deploys innovative, business relevant processes and solutions that drive the business strategy, talent management agenda, people engagement and organizational effectiveness and oversee service delivery (Time / Cost / Value / Quality / Direction / Strategy) according to internal and external service level agreements. * Provides coaching to managers on how to analyze and identify solutions to drive the business and create greater organizational capability and engagement. * Drives simplification and elimination of non-value-added work in the business and identifies efficiencies and drives organizational effectiveness. * Builds capability internally and coaches' senior leaders on effective talent, organizational and employee engagement strategies. * Drives culture change toward the direction of business (Understands the vision of the business, leads culture gap analysis, action plans against gaps, leverages communication tools/expertise to drive desired change) to ensure change initiative are managed in a predictable and controlled manner ensure overall objectives are achieved. * Leverages external networks to understand market trends, shape organizational strategy and apply leading practices. * Identifies the need for HR solutions and partners across HR to integrate and broker these services, overseeing and constantly improving a work-intake and contracting process to enable priorities and deliverables to emerge at enterprise, business unit and channel levels. * Other duties as assigned. ORGANIZATIONAL LEADERSHIP - EXPECTATIONS & REQUIREMENTS: Use Astute Judgment * Collaborates with corporate, regional, and A-Team members to achieve business results (e.g., HR Leader call, monthly HR regional meetings) and shares best practices and successes with others. * Viewed by and sought after by leaders as HR advisors and expert with ability to influence decision of others; trusted confidante to CEO (e.g., sought out for personal and professional advice and counsel) * Considers impact of HR decisions on the rest of the organization and therefore communicates across the organization to create awareness and gain support for HR decisions. * Provides leadership in building loyalty, trust, and commitment throughout the organization (e.g., leads and participates in employee advocacy and engagement programs, supports EES and creates action plans for improvement, leads recognition efforts for the facility) * Uses critical thinking and influencing skills to create organizational harmony when confronting divergent positions (e.g., uses metrics and data sources to support position and listens to all positions and counters/agrees professionally and in a timely manner) * Demonstrates business acumen when managing competing priorities (e.g., presents creative ways to address debate between budget constraints vs. need for additional resources by creating career ladders instead of changing pay practices) Develop Organizational Talent * Participates in workforce planning to ensure an adequate, competent, and productive workforce. Create/implement programs supporting the organization's future workforce needs (e.g., provides factual/current market position information, outlines obstacles/challenges and proposed solutions, creates annual long-term strategic workforce plan for facility, includes diversity/inclusion strategies in all aspects of business) * Leads the talent management strategies of the facility including recruitment and retention strategies and development of integrated succession plan ensuring continuity of business operations (e.g., creates development and succession plans for all leaders) * Effectively leads the pre-boarding, onboarding, orientation, and assimilation process for new employees (e.g., ensures 30/90-day reviews are conducted) * Leads goal setting and performance review process for facility. Conducts needs assessments and develops training and development programs to ensure goals are attained (e.g., ensures all processes are timely and accurate, development plans are created and followed up on, recommends T and D classes as needed, ensures mandated education is fulfilled without T/O due to timeliness) * Acts as effective coach and mentor to HR staff and leaders/staff outside HR as required. Aligns the Organization * Attends and contributes to the facility business planning process; ensures that the business plan aligns with the "people plan" as described in the HR workforce plan. * Creates, defends, and implements creative/innovative cost reduction strategies for the workforce ensuring that employee engagement and recruitment and retentions strategies are not compromised. * Provides global outlook on decisions and aligns with facility business plans when managing competing priorities; delegates to others as required and holds others accountable for results as demonstrated by timely, complete, and effective outcomes. * Provides timely responses to corporate and regional leadership ensuring timetables are consistently met (e.g., EAL complaints, Tenet Heroes submissions, TRIPP reports, Edu requirements, etc.) Optimize Execution * Consistent and timely administration and communicating of policies, regulations and legal mandates as stated by effective dates on document/policies, etc. Ensure responsible parties understand changes and any related actions. * Actively participates in and executes acquisitions and divestitures. HR lead for the facility in manpower planning, benefit, and compensation transitions, all on-boarding and off-boarding, as well as RIF notifications as required. * Completes and communicates final investigative results of ER/Labor relations or EAL complaints, or reasons for delay in issuing results, within 48 hours of receipt. * Collaborates with compensation and benefits to implement timely and effective compensation and benefit policies and programs (e.g., annual enrollment, new hire and termination requirements, wellness initiatives, etc.) * Collaborates with legal and ethics/compliance departments on matters related to the enforcement of policies and procedures as well as Tenet's "Standards of Conduct;" leads HR in all internal and external audits (e.g., Joint Commission, internal audits, etc.) Drive Organizational Success * Strategically develops and executes creative initiates to increase participation in the annual employee engagement survey; takes the lead in creating and driving facility action plans to completion through focus groups, training, and development, etc. * Actively works to improve the delivery and execution of HR programs and processes to increase operational effectiveness and efficiencies. Plans seamless transitions ensuring minimal disruption of workplace. * Understands and articulates HR policy, procedures, and protocols and is able to defend and support organization's position relative to same and confidently communicate changes. * Works with A-Team members to collaborate and deliver cross-functional programs and processes (e.g., cost reduction strategies, quality, and volume related incentive programs, etc.) * Leads and is held accountable for the "People Pillar" initiatives for the facility; actively participates in hardwiring and delivering retention strategies for the facility (e.g., leads TRIPP programs including bi-weekly calls as required) CANDIDATE EXPERIENCE, ATTRIBUTES AND EDUCATION REQUIREMENTS: * At least 10 years' experience in providing Human Resources services, solutions, and leadership in roles of different levels of size, complexity, business model maturity, etc. * Partnering with business leaders to develop, design and implement relevant strategic human resources strategies. * Ability to manage and develop senior HR functional and leadership capability. * Led organization design, restructuring and strategic workforce planning initiatives. * Has successfully led complex and system-wide organizational change that is a result of operating model transformation, business startup, mergers and acquisitions, business consolidation, etc. * Experience in creating and enhancing organizational culture through organizational effectiveness and development strategies that deliver higher levels of employee engagement, commitment, and satisfaction. * Highly skilled in executing "generalist" HR core processes in areas such as talent management, talent acquisition, employee relations, compensation, performance management, employee assessment and development, success planning and organizational development. * Diverse background in multiple industries and/or operating units within the same organization. PROFESSIONAL AND PERSONAL KNOWLEDGE, SKILLS, AND ABILITY REQUIREMENTS: * Skillful at influencing senior leaders and diverse perspectives towards common goals. * Able to surgically analyze and diagnose business and people performance, organizational climate and culture and use data to create insights that drive higher thinking and outcomes. * Ability to effectively balance enterprise and business specific requirements through high quality HR business partnering, superior consultative skills and knowledge of the business. * Developed, led, and implemented organization and functional change management strategies, initiatives, and process. * Ability to identify, develop and retain high quality talent balancing multiple engagement and reward levers to deliver overall individual and organization value and capability. * Ability to effectively manage a budget, interpret a P&L, understand key business drivers and has solid cost benefit trade off analysis and planning skills. * Ability to manage multiple priorities and initiatives keeping all in balance and delivering within cost, timing, change impact expectations. * Strong organization planning, critical thinking, and prioritization skills. * Ability to inspire and motivate all levels of the HR organization from the frontline to senior HR professionals. * Ability to develop strategy that can be translated into clear, concise, and actionable initiatives and action plans. * Demonstrates strong courageous leadership skills in the ability to make balanced, difficult, and complex decisions in the face of opposition. Education/Certifications * Bachelor's degree in human resource management or related field required. * Master's degree in human resources or related field (preferred). #LI-JK2 **********

A Business Development Associate is responsible for network development. In accordance with enterprise and local strategic priorities, this role will establish and foster outreach efforts with post-acute care, primary care, and/or non-Tenet acute care facilities that will support the growth and development of the Tenet network. Depending on market needs and leadership direction, this role entails the education of physicians, medical directors, administrators, nurse practitioners, practice managers, and/or schedulers from post-acute care facilities, primary care offices, and/or non-Tenet acute care facilities on our portfolio of hospital services. The objective is to increase the selection of our services by primary care offices, post-acute care facilities, and/or non-Tenet acute care facilities. All work, to be done in accordance with the Company's Standards of Conduct and policies and procedures, particularly those involving referral source arrangements. Primary Desired Outcome - Increase the selection of hospital services by providers via post-acute care facilities, the primary care setting and non-Tenet acute care facilities Primary Target Audience - Providers who do not have a working relationship with Tenet, as well as those that utilize Tenet for a portion of their services, sourced from primary care, post-acute care, and non-Tenet acute care facilities **********

DMC Rehabilitation Institute of Michiganis one of the nation's largest hospitals specializing in rehabilitation medicine and research. RIM is known for its clinical expertise in spinal cord injury, brain injury, stroke, amputee, orthopedics and catastrophic injury care. The Institute houses the Center for Spinal Cord Injury Recovery and the Southeastern Michigan Traumatic Brain Injury System (SEMTBIS), one of only 16 federally designated model systems of care for brain injury care and research. RIM also operates 31 outpatient sites throughout southeast Michigan specializing in sports medicine and orthopedics. Job Description: Under general supervision and according to established policies and procedures, plans, develops, implements and evaluates individualized exercise prescriptions and risk factor modification programs. Designs, implements and participates in educational programs for a variety of clients. Provides direction, assistance and instruction to support staff, as appropriate. Other Responsibilities include: * Performing daily checks and cleaning equipment * Supply management and calibration of equipment * Coordinate scheduling of stress tests Qualifications: 1. Bachelor of Science in Exercise Science or related health discipline (i.e., Physical Therapy, Physiology, Physical Education, Community Education) preferably with an internship experience. Masters degree preferred. 2. One to two years of clinical experience in a specialized area, such as Cardiology within a health care setting, preferred. 3. American College of Sports Medicine Certified Exercise Physiologist (ACSM-EP) certification preferred. 4. BLS and ACLS certification required within 6 months of hiring. 5. This position is for Cardiac Rehab phase II program. Job: Therapy and Rehabilitation Primary Location: Detroit, Michigan Facility: DMC Rehabilitation Institute of Michigan Job Type: Full Time Shift Type: Day ********** Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: *****************************

Up to $15,000 Sign on Bonus, based on amount of relevant experience DMC Detroit Receiving Hospital, Michigan's first Level I Trauma Center, helped pioneer the evolution of emergency medicine and currently has one of the busiest and most well-equipped emergency departments anywhere. The first and largest verified burn center in the state is at Receiving, and it is one of only 43 in the nation. Receiving also offers the state's leading 24/7 hyperbaric oxygen program, Metro Detroit's first certified primary stroke center, and the nationally recognized and accredited DMC Rosa Parks Geriatric Center of Excellence. Job Summary Under general supervision and following established policies and procedures, performs diagnostic Ultrasound exams utilizing appropriate imaging equipment. * Verifies patient identity and reviews patients medical record for appropriateness of exam or procedure. * Interviews patient to obtain, verify or update medical history and assesses risk factors such as medications, pregnancy and/or psychological indicators. * Explains procedure to patient, including side effects of pharmaceuticals administered, risks, benefits, alternatives and follow-up. * Sets up equipment and acquires appropriate images as per script. * Reviews images, makes initial observations, documents exceptions from established protocols and communicates data to radiologist. * Recognizes and responds to medical emergencies as appropriate. * Provides physician-prescribed post care instructions to patients. * Participates in process improvement activities within radiology practice including but not limited to quality of care, patient flow, reject-repeat analysis and patient satisfaction. Provides imaging education to residents, student technologists and new employees. Able to take call/standby as required by the department. Qualifications: 1. Registered by the American Registry for Diagnostic Medical Sonography (ARMDS) or registered by the American Registry of Radiologic Technologist (ARRT) in Sonography (S). 2. Required to have or successfully complete American Heart Association (AHA) Basic Life Support Healthcare Provider (BLS) training by end of orientation period. 3. Registered in specialty within 12 months of employment in area of discipline. Job: CT/MRI/Ultrasound Primary Location: Detroit, Michigan Facility: DMC Receiving Hospital Job Type: Full Time Shift Type: Night ********** Apply Now

Molina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Relations staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service. **Job Duties** This role serves as the primary point of contact between Molina Health plan and the Plan's Complex Provider Community that services Molina members, including but not limited to Value Based Payment and other Alternative Payment Method contracts. It is an external-facing, field-based position requiring an in-depth knowledge of provider relations and contracting subject matter expertise to successfully engage complex providers, including senior leaders and physicians, to ensure provider satisfaction, education on key Molina initiatives, and improved coordination and partnership. - Under general supervision, works directly with the Plan's external complex providers to educate, advocate and engage as valuable partners, ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service. - Resolves complex provider issues that may cross departmental lines including Contracting, Finance, Quality, Operations, and involve Senior Leadership. - Responsible for Provider Satisfaction survey results. - Develops and deploys strategic network planning tools to drive Provider Relations and Contracting Strategy across the enterprise. - Facilitates strategic planning and documentation of network management standards and processes. Effectiveness is tied to financial and quality indicators. - Works collaboratively with functional business unit stakeholders to lead and/or support various provider services functions with an emphasis on developing and implementing standards and best practices sharing across the organization. - MCST matrix team environmental support including, but not limited to: New Markets Provider/Contract Support Services, PCRP & CSST resolution support, and National Contract Management support services. - Serves as a subject matter expert for other departments. - Conducts regular provider site visits within assigned region/service area. Determines own daily or weekly schedule, as needed to meet or exceed the Plan's monthly site visit goals. A key responsibility of the Representative during these visits is to proactively engage with the provider and staff to determine, for example, non-compliance with Molina policies/procedures or CMS guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members. - Provides on-the-spot training and education as needed, which may include counseling providers diplomatically, while retaining a positive working relationship. - Independently troubleshoots problems as they arise, making an assessment when escalation to a Senior Representative, Supervisor, or another Molina department is needed. Takes initiative in preventing and resolving issues between the provider and the Plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters. - Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians. For example, such meetings would occur to discuss and resolve issues related to utilization management, pharmacy, quality of care, and correct coding. - Independently delivers training and presentations to assigned providers and their staff, answering questions that come up on behalf of the Health plan. May also deliver training and presentations to larger groups, such as leaders and management of provider offices (including large multispecialty groups or health systems, executive level decision makers, Association meetings, and JOC's). - Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives. Examples of such initiatives include: administrative cost effectiveness, member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, Provider Website, etc.). - Trains other Provider Relations Representatives as appropriate. - Role requires 40%+ same-day or overnight travel. (Extent of same-day or overnight travel will depend on the specific Health Plan and its service area.) **Job Qualifications** **REQUIRED EDUCATION** : Bachelor's Degree in a healthcare related field or an equivalent combination of education and experience. **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : - 4-6 years provider contract network relations and management experience in a managed healthcare setting. - Working experience servicing complex providers with various managed healthcare provider compensation methodologies, including but not limited to: fee-for service, value-based contracts, capitation and various forms of risk, ASO, etc. **PREFERRED EDUCATION** : Master's Degree in Health or Business related field **PREFERRED EXPERIENCE** : - 5 years experience in managed healthcare administration. - Specific experience in provider services, operations, and/or contract negotiations in a Medicare and Medicaid managed healthcare setting, ideally with different provider types (e.g., physician, groups and hospitals). To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $60,415 - $117,809 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

DMC University Laboratories, Inc. is committed to providing exceptional patient care in a supportive and collaborative environment. As a member of our team, you will have the opportunity to work with advanced technology and be part of a healthcare community dedicated to making a positive impact on the lives of our patients. Benefits Statement At Tenet Healthcare, we understand that our greatest asset is our dedicated team of professionals. That's why we offer more than a job - we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include\: • Medical, dental, vision, and life insurance • 401(k) retirement savings plan with employer match • Generous paid time off (PTO) • Career development and continuing education opportunities • Health savings accounts, healthcare & dependent flexible spending accounts • Employee Assistance program, Employee discount program • Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance. Note\: Eligibility for benefits may vary by location and is determined by employment status Job Summary Under general supervision and according to specific and detailed procedures, accurately performs specific pre-analytical and post-analytical tasks. Processes information by compiling, categorizing, calculating, tabulating, auditing, or verifying information or data with attention to detail. Interacts with patient and other health care professionals, and responds to routine inquiries. Inspects and maintains work area, instruments, and supplies. Promotes DMC values by demonstrating behaviors supportive of building a High Reliability Culture committed to Safety for Life, Health for Life, Customer Service, Community Welfare, Excellence, Respect, Integrity, Accountability, Innovation, Teamwork and Effective Resource Use. Responsibilities 1. Prioritizes incoming specimens; processes patient specimens in accordance with department safety and OSHA guidelines. Ensures stats and other critical tests are accurately and immediately processed. Documents specimen problems and refers to supervisor or other lead designee. 2. May draw blood samples from patients based on physicians order and in accordance with departmental safety and OSHA guidelines (e.g. utilizes protective equipment such as gloves, coats, and shields); verifies patients identification and collects insurance information. 3. Generates and attaches labels to specimen/blood samples; may perform specimen processing and aliquoting according to pre-established test requirements. 4. Ensures specimen integrity by verifying patient identification and ensures the sample submitted is appropriate given the requested test. Sorts, racks, and delivers specimens to appropriate testing laboratory. 5. Accurately enters and reviews laboratory test data in the laboratory computer system; detects and corrects errors according to laboratory policies and quality standards. 6. Communicates with patients to explain procedures and/or answers routine questions from physicians, nurses, or other appropriate healthcare professionals (e.g. date or time of drawing patients blood or gathering specimens, verifying a request, etc.) 7. Maintains a neat and clean work area; stocks storage area with supplies and inventories as necessary. Cleans glassware, equipment, and small instruments. 8. May perform transportation duties (e.g. delivers specimens and reports); time stamps or computer verifies all laboratory requests; may order tests in the system. 9. May conduct routine inspection, maintenance and quality control checks on equipment (e.g. records temperatures). Reports unusual findings timely to supervisor or lead designee. 10. May prepare the patient for and/or administer tolerance tests or other tests specific to assigned area. 11. Performs a variety of clerical duties such as answering the telephone, scheduling appointments, maintaining records, or relaying a message to the appropriate personnel. 12. Self-monitors their individual work behavior and performance to make improvements. Communicates training and development needs to management. 13. Complies with departmental safety polices and procedures and OSHA guidelines, including the use of applicable personal protective equipment. 14. Responsible to check organizational communication daily (i.e. Outlook, laboratory software, posted notices, etc.) 15. Performs other related duties as assigned. 1. High school diploma or equivalent education required. 2. Candidate must have six (6) months experience in medical training ,and/ or certification in a health care environment or related science field. (i.e. Lab Assistant, Medical Assistant, Nursing Assistant, Phlebotomist or Health Science studies.) 3. Basic studies in medical terminology or a related health science field preferred. 4. Customer service experience in a service environment preferred. 5. For Phlebotomists - Phlebotomy Certification is preferred. Facility Description DMC University Laboratories (DMCUL) is a regional, integrated laboratory system providing services to the eight hospitals of Detroit Medical Center. DMC University Laboratories evolved in 1993 and is comprised of Core Laboratories, Specialty Laboratories, two rapid response hospital laboratories, Centralized Stat Lab, Centralized Blood Bank Lab, and full service outreach infrastructure which includes patient service centers, remote ambulatory laboratories, marketing staff, courier system and billing department. The DMC University Laboratories service area covers the entire Southeast Michigan market, and is growing at a rapid pace with the following outstanding features\: Test menu of over 1,000 tests, which includes high end specialty tests. Less than 1% of our tests are sent to outside reference laboratories. Provide reference laboratory services to many of the other healthcare systems in Southeastern Michigan and several out of state facilities. EEO Statement Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify\: http\://********************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations JOIN OUR TEAM QUALITY CARE DELIVERED BY COMPASSIONATE PEOPLE We know it takes a special person to work in healthcare, and we are committed to providing our people with an enriching and rewarding environment. We deliver the resources, tools and support our employees need to serve our patients and customers in the best way possible - so we can create happier, healthier communities. COMMITTED TO DIVERSITY AND INCLUSION At Tenet, we believe in a diverse and inclusive environment, one that is grounded in our dedication to the health and well-being of all people. Respecting, nurturing and encouraging diversity of thought, background and experience contribute to positive work environments that result in exceptional patient care. We embrace diversity because it's our culture, and because it's the right thing to do.

Are you a results-driven leader ready to make a meaningful impact to patients, caregivers, and your community? At DMC Harper University/Hutzel Women's Hospital, we're seeking an innovative and experienced healthcare leader to drive excellence and inspire our team towards exceptional patient outcomes and operational success. Benefits Statement At Tenet Healthcare, we understand that our greatest asset is our dedicated team of professionals. That's why we offer more than a job - we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include\: • Medical, dental, vision, and life insurance • 401(k) retirement savings plan with employer match • Generous paid time off (PTO) • Career development and continuing education opportunities • Health savings accounts, healthcare & dependent flexible spending accounts • Employee Assistance program, Employee discount program • Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance. Note\: Eligibility for benefits may vary by location and is determined by employment status Job Summary Directs, develops, implements, maintains and evaluates a comprehensive Environmental, Safety, Regulatory Compliance and Emergency preparedness program for the Environment of Care (EC) program in one or more operating units and multiple ambulatory locations in accordance with all local, state and federal safety codes and standards. Serves as the Site Environmental Management Representative for the ISO 14001 program. Provides technical support to Directors/Managers of site departments in addressing hazards and implementation of controls that will provide for a safe working environment. Conducts inspections and maintains appropriate documentation to ensure compliance with various regulatory agencies and licensing bodies. Serves or chairs various EC committees and work groups on safety related issues. Develops policies, intervenes in situations that pose an immediate safety threat, reviews accident and incidents occurring to employees, patients, visitors and others, reviews accident/incident reports to ascertain cause, and serves as the sites authority in safety related areas. Acts as liaison in safety and environmental inspections with external regulatory agents. Manages federal emergency management grants. Provides direction to subordinate staff as required. 1. Bachelors of Science degree in safety management, occupational health and safety, industrial hygiene or related field, or the equivalent combination of education and experience. 2. Three to five years related experience, preferably in hospital operations, including experience related to the following\: The JC, MIOSHA, DEQ, NFPA,CAP, CARF, CMS, Michigan Department of Community Health, and NIMS-ICS, City and State Fire Safety Regulations as well as local, state and federal regulating agencies. Safety Management, Fire Safety, Hazardous Material Management, ISO 14001, and local and regional Emergency Preparedness. 3. Qualification as a certified healthcare safety professional (CHSP) within three years of hire into the Safety Director job classification. Facility Description DMC Harper University Hospital has distinguished itself in surgery and medicine and is known for its clinical expertise and innovative research. A specialty referral hospital, Harper has established Centers of Excellence in neurosciences, bariatric surgery, vascular services, multidisciplinary cardiovascular services, hypertension, stroke prevention and heart failure. EEO Statement Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify\: http\://********************** JOIN OUR TEAM QUALITY CARE DELIVERED BY COMPASSIONATE PEOPLE We know it takes a special person to work in healthcare, and we are committed to providing our people with an enriching and rewarding environment. We deliver the resources, tools and support our employees need to serve our patients and customers in the best way possible - so we can create happier, healthier communities. COMMITTED TO DIVERSITY AND INCLUSION At Tenet, we believe in a diverse and inclusive environment, one that is grounded in our dedication to the health and well-being of all people. Respecting, nurturing and encouraging diversity of thought, background and experience contribute to positive work environments that result in exceptional patient care. We embrace diversity because it's our culture, and because it's the right thing to do.

Detroit Medical Center (DMC) is committed to providing exceptional patient care in a supportive and collaborative environment. As a member of our team, you will have the opportunity to work with advanced technology and be part of a healthcare community dedicated to making a positive impact on the lives of our patients. Benefits Statement At Tenet Healthcare, we understand that our greatest asset is our dedicated team of professionals. That's why we offer more than a job - we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include: * Medical, dental, vision, and life insurance * 401(k) retirement savings plan with employer match * Generous paid time off (PTO) * Career development and continuing education opportunities * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance. Note: Eligibility for benefits may vary by location and is determined by employment status Job Summary Tenet Healthcare is a leading healthcare services company with a vast network of providers that we leverage to improve service delivery and patient outcomes.Our mission is to provide quality, compassionate care in the communities we serve. To this end, we seek and develop talent that will reflect this commitment to our mission and values. Under the guidance of the Market Education Director, the Nursing Educator collaborates with facility/market nursing leadership and staff across departments to assess, plan, develop, implement, facilitate, evaluate and revise educational programming for all levels of nursing personnel and non-nursing personnel as indicated or requested. The educator acts as a key resource in the orientation and continuing education of nursing staff at Tenet Healthcare. The Nursing Educator implements a comprehensive education program for his/her assigned units while following and contributing to Tenet educational goals and vision. Educational programs typically include, but are not limited to orientation, continuing education and in-services. Other services may include, but are not limited to process, performance and service-delivery consultation and contributions to the organization through councils, committees and workgroups. Responsibilities Clinical Education * Supports the educational needs for assigned units/clinics including classroom, clinical experiences and learning technologies. * Implements Tenet comprehensive education programs to meet the orientation and ongoing competency needs and professional development needs of the nursing staff, with specific focus for his/her units/clinics, which supports the Tenet model of professional nursing practice. * Ensures all program/ course revisions meet the Department of Nursing and regulatory expectations and standards. Adheres to national education practice standards and stays abreast of current research into nursing education practice. Programs are executed and revised based on adult learning principles, organizational and learning theory consistent with Tenet endorsed philosophy and direction. * Provides consultation to enhance continuing education, professional development opportunities and mentorship opportunities. * Delivers/coordinates other educational programs as directed (e.g., Grand Rounds, in-services, continuing education, job-specific and specialty curricula) to support competence and professional growth of Tenet nursing staff. * Provides leadership to preceptors and serves as a role model through educational programs and ongoing coaching and mentoring. * Serves as a facilitator to nurse residents and actively mentors and supports their growth in the profession and clinical practice. * Participates in continuing education provider unit learning. Evaluates nursing education activities which qualify for continuing education credit. Participates in activities to keep abreast of the changes to market/facility policies/procedures of the provider unit, and the expectations of the educator role. * Assists in development of clinical policies and procedures as requested. * Provides guidance, resources and knowledge for professional growth of others. * Mentors colleagues, other nurses, students and others as appropriate. * Participates in quality performance improvement activities. * Performs other duties as assigned/required. Peri-Operative Services * Covers Services but not limited to: * Anesthesia * Endo * Sterile Processing * Radiology/IR/Neuro IR * Pt Transporters * Accountable for the Projects, such as but not limited to: * Crash Cart * Moderate Sedition * Ortho Program * Malignant Hyperthermia ALL DUTIES AND REQUIREMENTS MUST BE PERFORMED CONSISTENT WITH TENET HEALTHCARE PERFORMANCE STANDARDS Qualifications: Minimum Qualifications 1. Bachelor's Degree in Nursing or Nursing Education or related specialty 2. 2 year nursing experience in an acute care setting preferred 3. Current State Licenses & Certifications Skills Required * Participates in projects and educational activities as assigned for the department * Communicates effectively with colleagues across Tenet to advance goal achievement and strategic vision alignment * Demonstrates skill in navigating and communicating in a complex environment. Fosters achievement of Nursing Education/Development goals and objectives * Demonstrates responsibility for reporting to licensing, certification, accreditation, and other regulatory bodies for educational program compliance * Interacts with staff in an ethical, consistent, fair, timely, appropriate, and decisive manner in accordance with organization-wide and Nursing Department policies * Identifies factors that affect staff's ability to fulfill their job responsibilities, collaborates with management to effect appropriate change needed for employee's success * Accepts Committee and market work group appointments and actively participates to affect change in patient care and the Tenet Healthcare System * Cultivates positive relationships with academic programs to foster positive image and relationships with Tenet Healthcare. * Demonstrates AIDET and respect for others at all times Facility Description The Detroit Medical Center (DMC) is a nationally recognized health care system that serves patients and families throughout Michigan and beyond. A premier healthcare resource, our mission is to help people live happier, healthier lives. The hospitals of the Detroit Medical Center are the Children's Hospital of Michigan, Detroit Receiving Hospital, Harper University Hospital, Hutzel Women's Hospital, the DMC Heart Hospital, Huron Valley-Sinai Hospital, the Rehabilitation Institute of Michigan and Sinai-Grace Hospital. DMC's 150-year legacy of medical excellence and service provides patients and families world-class care in cardiovascular health, women's services, neurosciences, stroke treatment, orthopedics, pediatrics, rehabilitation, organ transplant and other general and specialty services. DMC is a key partner in Detroit's resurgence, which continues to draw national and international attention. A dedicated corporate citizen with strong community ties, DMC is one of the largest and most diverse employers in Southeast Michigan. EEO Statement Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations Job: Educators/Specialists/Advanced Practice Primary Location: Detroit, Michigan Facility: Detroit Medical Center Shared Services Job Type: Full Time Shift Type: Day Shift Begin: 7:00 AMShift End: 3:30 PM ********** Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: *****************************

The Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. The SIU Investigator is responsible for reviewing and analyzing information to draw conclusions on allegations of FWA and/or may determine appropriateness of care. The SIU Investigator is also responsible for recognizing and adhering to national and local coding and billing guidelines in order to maintain coding accuracy and excellence. The position also entails producing audit reports for internal and external review. The position may also work with other internal departments, including Compliance, Corporate Legal Counsel, and Medical Officers in order to achieve and maintain appropriate anti-fraud oversight. **Job Duties** + Responsible for developing leads presented to the SIU to assess and determine whether potential fraud, waste, or abuse is corroborated by evidence. + Conducts both preliminary assessments of FWA allegations, and end to end full investigations, including but not limited to witness interviews, background checks, data analytics to identify outlier billing behavior, contract and program regulation research, provider and member education, findings identification and communications development, and recommendations and preparation of overpayment identifications and closure of investigative cases. + Completes investigations within the mandated period of time required by either state and/or federal contracts and/or regulations. + Conducts both on-site and desk top investigations. + Conducts low to medium, and extensive investigations, including reviews of medical records and data analysis, and makes determinations as to whether the investigation and/or audit identified potential fraud, waste, or abuse. + Coordinates with various internal customers (e.g., Provider Services, Contracting and Credentialing, Healthcare Services, Member Services, Claims) to gather documentation pertinent to investigations. + Detects potential health care fraud, waste, and abuse through the identification of aberrant coding and/or billing patterns through utilization review. + Prepares appropriate FWA referrals to regulatory agencies and law enforcement. + Documents appropriately all case related information in the case management system in an accurate manner, including storage of case documentation following SIU related requirements. Prepares detailed preliminary and extensive investigation referrals to state and/or federal regulatory and/or law enforcement agencies when potential fraud, waste, or abuse is identified as required by regulatory and/or contract requirements. + Renders provider education on appropriate practices (e.g., coding) as appropriate based on national or local guidelines, contractual, and/or regulatory requirements. + Interacts with regulatory and/or law enforcement agencies regarding case investigations. + Prepares audit results letters to providers when overpayments are identified. + Works may be remote, in office, and on-site travel within the state of New York as needed. + Ensures compliance with applicable contractual requirements, and federal and state regulations. + Complies with SIU Policies as and procedures as well as goals set by SIU leadership. + Supports SIU in arbitrations, legal procedures, and settlements. + Actively participates in MFCU meetings and roundtables on FWA case development and referral **JOB QUALIFICATIONS** **Required Education** Bachelors degree or Associate's Degree, in criminal justice or equivalent combination of education and experience **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** + 1-3 years of experience, unless otherwise required by state contract + Proven investigatory skill; ability to organize, analyze, and effectively determine risk with corresponding solutions; ability to remain objective and separate facts from opinions. + Knowledge of investigative and law enforcement procedures with emphasis on fraud investigations. + Knowledge of Managed Care and the Medicaid and Medicare programs as well as Marketplace. + Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems. + Understanding of datamining and use of data analytics to detect fraud, waste, and abuse. + Proven ability to research and interpret regulatory requirements. + Effective interpersonal skills and customer service focus; ability to interact with individuals at all levels. + Excellent oral and written communication skills; presentation skills with ability to create and deliver training, informational and other types of programs. + Advanced skills in Microsoft Office (Word, Excel, PowerPoint, Outlook), SharePoint and Intra/Internet as well as proficiency with incorporating/merging documents from various applications. + Strong logical, analytical, critical thinking and problem-solving skills. + Initiative, excellent follow-through, persistence in locating and securing needed information. + Fundamental understanding of audits and corrective actions. + Ability to multi-task and operate effectively across geographic and functional boundaries. + Detail-oriented, self-motivated, able to meet tight deadlines. + Ability to develop realistic, motivating goals and objectives, track progress and adapt to changing priorities. + Energetic and forward thinking with high ethical standards and a professional image. + Collaborative and team-oriented **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION** : + Valid driver's license required. **PREFERRED EXPERIENCE** : At least 5 years of experience in FWA or related work. **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION** : + Health Care Anti-Fraud Associate (HCAFA). + Accredited Health Care Fraud Investigator (AHFI). + Certified Fraud Examiner (CFE). To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.82 - $51.06 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides entry level support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** - Enters denials and requests for appeals into information system and prepares documentation for further review. - Researches claims issues utilizing systems and other available resources. - Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. - Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research. - Determines appropriate language for letters and prepares responses to member appeals and grievances. - Elevates appropriate appeals to the next level for review. - Generates and mails denial letters. - Provides support for interdepartmental issues to help coordinate problem-solving in an efficient and timely manner. - Creates and/or maintains appeals and grievances related statistics and reporting. - Collaborates with provider and member services to resolve balance bill issues and other member/provider complaints. **Required Qualifications** - At least 1 year of experience in claims, and/or 1 year of customer/provider service experience in a health care setting, or equivalent combination of relevant education and experience. - Customer service experience. - Organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting experience. - Completion of a health care related vocational program (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $34.88 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.