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Description The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within ..
Job ID 21000LWUAvailable Openings 1PURPOSE AND SCOPE: Supports FMCNA’s mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements. ..
Description The Quality Compliance Professional 2 completes annual quality reviews and research. The Quality Compliance Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate ..
Description Senior Compliance Professional ensures compliance with governmental requirements as they ... Medicaid State reporting. The Senior Compliance Professional work assignments involve moderately ... variable factors. Responsibilities The Senior Compliance..
Job Information Humana Care Guide - Physical Health in Lima Ohio Description The Care Guide (Care Coach 1) assesses and evaluates member's needs and requirements to achieve and/or maintain optimal wellness ..
Description The Behavioral Health Market Development Advisor provides support to assigned health plan and/or specialty companies relative to Medicare/Medicaid/TRICARE/Employer Group product implementation, operations, contract compliance, and federal contract application submissions. The ..
Job Information Humana Manager, Care Management(Behavioral Health) - Ohio Medicaid in Lima Ohio Description Humana Healthy Horizons in Ohio is seeking Managers of Care Management who will lead our behavioral health ..
Job Information Humana Care Manager, Registered Nurse, RN - Maternity, L&D, Mother Baby in Lima Ohio Description The Field Care Manager assesses and evaluates member's needs and requirements to achieve and/or ..
Job Information Humana Quality Improvement Coordinator in Lima Ohio Description The Quality Improvement Coordinator 3 assists in administering and monitoring quality improvement and compliance processes for the Ohio Medicaid program. The ..
Description The Provider Contracting Executive initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Provider Contracting Executive works on problems ..
... fraud, waste, and abuse (FWA) compliance program to prevent and detect ... out the provisions of the compliance plan, including FWA policies and ... Oversee internal investigations of FWA..
Description Humana is a $90 billion (Fortune 40) market leader in integrated healthcare with a clearly defined purpose to help people achieve lifelong well-being. As a company focused on the health ..
Description The Senior Quality Compliance Nurse Professional is an integral part of the Ohio Quality Improvement Department. This role will collaborate with internal and external customers to complete fast-paced and time ..
Description Humana Healthy Horizons in Ohio is seeking Managers of Care Management (Physical Health & Behavioral Health) who will lead our physical or behavioral health care management operations and staff to ..
Job Information Humana Senior Provider Contracting Professional - Remote (EST Hours) in Lima Ohio Description The Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital, and/or other provider contracts and ..
Job Information Humana Care Manager, Licensed Behavioral Health Professional or Registered Nurse in Lima Ohio Description The Field Care Manager, Behavioral Health 2 (Care Manager, Behavioral Health) assesses and evaluates member's ..
Description The Manager, Risk Adjustment oversees coding educators and quality assurance audits of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS). ..
