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Description The RN, Compliance Nurse 2 reviews utilization management ... waste, and abuse. The RN Compliance Nurse 2 work assignments are ... of action. Responsibilities The RN Compliance Nurse 2..
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 ..
... all utilization reviews are in compliance with the terms of the ... procedural and Florida Agency for Healthcare Administration (ACHA). Ensure adoption and ... contract changes and/or updates. Maintain..
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..
Description Humana Healthy Horizons in Florida is seeking an Associate Director, Care Management who will lead teams of nurses and behavior health professionals responsible for care management. The Associate Director, Care ..
Description The Manager, Utilization Management Nursing utilizes clinical ... and/or benefit administration determinations. The Manager, Utilization Management Nursing works within ... you succeed, we succeed! The Manager, Utilization Management Nursing..
Job Information Centerwell RN Clinical Manager in Tallahassee Florida The Clinical ... in Tallahassee Florida The Clinical Manager coordinates and oversees all direct ... to ensure documentation is in compliance..
... direction of a RN in compliance with the state's Nurse Practice ... any applicable licensure/certification requirement, applicable healthcare standards, governmental laws and regulations, ... contact with patients, physicians, clinical..
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). ..
Description Humana Healthy Horizons in Florida is seeking an Associate Director, Care Management leads teams of nurses and behavior health professionals responsible for care management. The Associate Director, Care Management requires ..
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 Community Health Worker contributes to the administration of Care Management and Utilization Management. The individual in this role provides non-clinical support to the assessment and evaluation of member's needs ..
