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Description Humana's recently created Clinical Resource Team is looking to grow the team with a couple Senior Nurse Auditor roles! This is a unique team that's primary role is to quickly ..
Description The Behavioral Health Clinical Advisor (Care Manager, Telephonic Behavior Health 2) will audit CPT (Current Procedural Terminology) codes to ensure correct billing under TOM (TRICARE Operations Manual) policies in accordance ..
Description The Process Improvement Professional 2 analyzes, and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Process Improvement Professional 2 work assignments ..
... The Associate Director for ACD Audit , at the director of ... Orders, for ACD Program Integrity Audit; driving to operational excellence, repeatable ... system needs, data needs, provider..
Description The Risk Management Professional 2 a critical member within Humana's Third Party Risk Management Program (TPRM), a 2nd Line of Defense function, will be responsible for maturing our program by ..
Description The Supervisor, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Supervisor, Compliance ..
Description The Behavioral Health Parity Compliance Lead will play an integral role in the oversight and management of our Mental Health Parity Compliance Program. Responsibilities This role is responsible for monitoring ..
Description The Senior Clinical Fraud and Waste Professional performs analysis of clinical investigations of allegations of fraudulent and abusive practices. The Senior Clinical Fraud and Waste Professional work assignments involve moderately ..
Description The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. The ..
Description The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. Responsibilities ..
... is looking for an experienced Healthcare Investigator to join its industry ... billing practices. Prepares investigative and audit reports. Begins to influence department's ... areas Bachelor's degree or significant..
Description The Senior Compliance Professional ensures compliance with governmental requirements. The Senior Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an ..
Description Humana's recently created Clinical Resource Team is looking to grow the team with a Senior Nurse Auditor roles! This is a unique team that's primary role is to quickly jump ..
Job Information Humana Nurse Auditor 2/ER - WFH/REMOTE-- Anywhere in the US in Dover Delaware Description The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and ..
... looking for an experienced Senior Healthcare Investigator to join its industry ... practices. Prepares complex investigative and audit reports. Begins to influence department's ... Qualifications Bachelor's degree or significant..
Job Information Humana Senior Risk Management Professional - Third Party Risk Management-Remote, US in Dover Delaware Description The Senior Risk Management Professional a critical member within Humana's Third Party Risk Management ..
... Compliance & Risk Management Quality Audit (QA) Risk Management Professional 2-Remote, ... Compliance & Risk Management Quality Audit (QA) Risk Management Professional 2, ... include: Collaborate with the Quality..
Description The Senior Risk Management Professional will be responsible for managing third party risk management (TPRM) work streams to support Humana's overall TPRM Program. Responsibilities include risk identification, data analysis, process ..
Job Information Humana Medicaid Associate Director, Compliance Nursing in Dover Delaware Description The Associate Director, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations ..
... implement and maintain clinical lab audit concepts. The Nurse Auditor 2 ... Auditor 2 will perform clinical audit and validation processes to ensure ... implement and maintain clinical lab..
