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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 Senior Compliance Professional ensures compliance with governmental requirements. The Senior ... with governmental requirements. The Senior Compliance Professional work assignments involve moderately ... variable factors. Responsibilities Seeking Senior..
... Information Humana Actuary, Risk and Compliance in Glen Allen Virginia Description ... within the Senior Products Actuarial Compliance team focused on special Medicare ... special programs, this role supports..
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 ..
... whether services provided by other healthcare professionals are in agreement with ... of services provided by other healthcare professionals in compliance with review policies, procedures, and ... with a..
... the global leader in dialysis healthcare, we form bonds that enable ... philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory ... a member of the interdisciplinary..
Description The Supervisor, Compliance Nursing reviews utilization management activities ... waste, and abuse. The Supervisor, Compliance Nursing works within thorough, prescribed ... analytical approach. Responsibilities The Supervisor, Compliance Nursing ensures..
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 ..
Description The Director, Pharmacy Clinical Formulary and Medical Drug Strategies oversees and drives the pharmacy and medical drug formulary strategies across all lines of business (Medicare, Commercial, Medicaid). This position will ..
... social determinants and obtaining timely healthcare. The Lead Medical Director provides ... of services provided by other healthcare professionals in compliance with review policies, procedures, and ... to BH..
... looking for an experienced Senior Healthcare Investigator to join its industry ... a thorough investigation to maintain compliance with Humana and governmental requirements ... external partners (Law Enforcement, Legal,..
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..
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 ..
... philosophy. Adheres to the FMCNA Compliance Program, including followingall regulatory and ... and other members of the healthcare team to interpret, adjust, and ... delivery of patient care in..
Description The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All ..
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 ..
Job Information Humana FP&A Lead, Medicaid Market in Glen Allen Virginia Description The Financial Planning & Analysis Lead is acritical leadership role with full market financial oversight over the South Carolina ..
... is looking for an experienced Healthcare Investigator to join its industry ... a thorough investigation to maintain compliance with Humana and governmental requirements ... external partners (Law Enforcement, Legal,..
