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Description Responsibilities The Associate Director for ACD Audit , at the director of the Director of Payment Integrity, will create and implement process improvement plans focused on the beneficiary and provider ..
Description This role has responsibility for the oversight and monitoring of the Autism Care Demonstration (ACD) team performance to ensure compliance with contract and complex ACD policy requirements as defined by ..
Description The Referrals Coordinator 2 process referrals from Military Treatment Facilities (MTFs) and civilian providers. The Referrals Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically ..
Description Humana is continuing to grow nationwide! We have 28 new Bilingual Medicaid Inbound Contact Representative openings that will have the pleasure of taking inbound calls from our Florida Medicaid Members ..
Description The Bilingual Manager, Learning Facilitation , plans, coordinates, and implements all aspects of training programs for participants throughout for Grievance and Appeals / Careplus. EST states Responsibilities The Bilingual Grievances ..
Description Benefits ESSENTIAL DUTIES AND RESPONSIBILITIES OF THE POSITION 1. Complete all data collection and analysis, which includes compiling, processing, and documenting data regarding program outcomes, funding reports, and documentation to ..
Qualifications nn n Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met.nnBasic Requirements:nntCitizenship: Citizen ..
Job Information Humana Bilingual Quality Auditor in Cincinnati Ohio Description The Bilingual Quality Auditor/ Professional 2 ensures that products meet specific Centers for Medicaid and Medicare Services standards of quality. Review ..
Description The DRG Validation Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM and PCS) to patient records. The Medical ..
Description The Behavioral Health Medical Director makes determinations regarding prior authorization and retrospective reviews for inpatient and outpatient services to ensure that members receive clinically appropriate and medically necessary services. All ..
Description The Medical Director's primary responsibility is the review of medical authorizations or claims to determine the medical necessity of a given service or level of care. The Medical Director's work ..
Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part C Line of Business. The Medical Director provides medical interpretation and determinations ..
Description Humana is seeking a Senior Communications and Marketing Professional to join our growing team. The Senior Communications and Marketing Professional will create and lead strategy for Humana's Wisconsin Medicaid Market ..
Description The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All ..
Description Are you passionate about contributing to the well-being of the Medicare population? Are you looking for a role that will let your creative ideas, relationship management and sales ability shine? ..
Facility: HOME CARE (EAST) Job Description: Promotes health and healing by functioning as a member of the care team to provide optimum care for convalescent, acutely/chronically ill, home care and long-term ..
Description The Quality Improvement Professional 2 assists in implementing quality improvement and collaborative projects for Ohio's Medicaid program. The Quality Improvement Professional 2 assignments involve the analysis of situations or data ..
Job Description As a Delivery Driver and Pharmacy Technician for Omnicare Pharmacy, you will deliver prescription orders and/or products to customers on a predetermined route and schedule. Delivery drivers and pharmacy ..
Qualifications nn n Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met.nnBasic Requirements:nntUnited States ..
Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires ..
Description The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations. The Behavioral Health Medical Director work assignments involve moderately complex to complex issues where the analysis of ..
