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Description The Risk Adjustment Representative 2 conducts quality assurance audits of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other ..
Description The Care Manager, Telephonic Nurse 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and ..
... hours as-needed. The On-Call Scheduling Specialist performs varied activities and moderately ... of the branch, the Scheduling Specialist may be responsible for part ... School Diploma or equivalent Excellent..
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 ..
Job ID 21000LYEAvailable Openings 1Position Specific Information Richmond South location - Ricmond, VA Dialysis experience is required RN license is required PURPOSE AND SCOPE: Supports FMCNA’s mission,vision, core values and customer ..
... in large, complex, and integrated healthcare or payer setting Experience in ... or payer setting Experience in healthcare management and/or operations, Provider Practice/Healthcare or medical center operations Ability .....
... wellbeing of members. The Support Specialist performs varied activities and moderately ... interdisciplinary team. Responsibilities The Support Specialist daily assignments are focused on ... Qualifications 1- 3 years of..
... is looking for an experienced Healthcare Investigator to join its industry ... areas Bachelor's degree or significant healthcare fraud and investigation experience At ... At least 1 year of..
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 ..
... wellbeing of members. The Support Specialist performs varied activities and moderately ... Responsibilities Job Description The Support Specialist daily assignments are focused on ... Qualifications 1- 3 years of..
... the global leader in dialysis healthcare, we form bonds that enable ... a member of the interdisciplinary healthcare team, supporting the FMCNA commitment ... relationships through effective and timely..
Description The Supervisor, UM Administration contributes to administration of utilization management. The Supervisor, UM Administration works within thorough, prescribed guidelines and procedures; uses independent judgment requiring analysis of variable factors to ..
Description The Supervisor, Pre-Authorization Nursing reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The Supervisor, Pre-Authorization ..
Description The Medical Record Retrieval Specialist (Risk Adjustment Representative) travels to provider offices within the region and scans medical records into a secure system. The records are reviewed by Humana's Coding ..
Description Do you thrive on working on the cutting edge? Working with innovators in the early stages of ideas, products, or platforms? Do you want to transform an industry? Crave new ..
Description The Care Manager, Telephonic Nurse 2 employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder ..
Oncology Business Specialist -- Richmond, VA Do you ... is announcing an Oncology Business Specialist opportunity in the Philadelphia, PA ... satisfaction in territory. Maintain effective communication and relationships with..
Performance Improvement Consultant - Healthcare Revenue Cycle Services Overview of ... cross-functional teams. The Performance Improvement Specialist will be responsible for monitoring ... experience in front/middle and back-end healthcare revenue..
... Certified Diabetes Care and Education Specialist-Remote-US in Glen Allen Virginia Description ... Certified Diabetic Care and Education Specialist (CDCES) delivers comprehensive and seamless ... Certified Diabetes Care and Education..
