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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..
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 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 ..
... procedures, and training and in compliance with regulations set forth by ... other PCT’s.Collaborates with the Clinical Manager and Education Coordinator in driving ... systems incorporated into training, including..
Job Information Humana Care Manager, Licensed Behavioral Health Professional or ... Ohio Description The Field Care Manager, Behavioral Health 2 (Care Manager, Behavioral Health) assesses and evaluates ... members. Responsibilities..
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). ..
... 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..
... care, services, and supports in compliance with Ohio Department of Medicaid ... policies and procedures to ensure compliance with state and federal requirements ... years' experience working in the..
Job Information Humana Manager, Care Management(Behavioral Health) - Ohio ... care, services, and supports in compliance with Ohio Department of Medicaid ... policies and procedures to ensure compliance with state..
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 Manager, Registered Nurse, RN - Maternity, ... Ohio Description The Field Care Manager assesses and evaluates member's needs ... members. Responsibilities The Field Care Manager Nurse..
