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... Humana Senior Process Improvement Professional (HealthCare, Provider Value exp.) Work at ... Medicaid business partners, including: Contracting, Credentialing, Referral/Authorizations, Claims, Grievance and Appeals, ... a Bachelor's degree in Business,..
Job ID 21000JNHAvailable Openings 1PURPOSE AND SCOPE: The Inpatient RN provides direct patient care in accordance to company policies and procedures which includes FMCNA compliance programs and contracted hospitals’ policies and ..
Description The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. The ..
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 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 ..
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 ..
PURPOSE AND SCOPE:The Inpatient RN provides direct patient care in accordance to company policies and procedures which includes FMCNA compliance programs and contracted hospitals’ policies and procedures. Areas of practice are ..
PURPOSE AND SCOPE: Provides psychosocial services to patients treated by the facility including in-center and home dialysis patients (if applicable) utilizing Social Work Theory of Human Behavior and accepted methods of ..
... of services provided by other healthcare professionals in compliance with review ... whether services provided by other healthcare professionals are in agreement with ... organizations, and able to pass..
Job Information Humana Medicare Appeals and Grievance Medical Director in San Juan Puerto Rico Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for ..
Job Information Humana Medical Director - Medicare Pharmacy Appeals in San Juan Puerto Rico Description The Medical Director relies on clinical background and reviews Medicare drug requests. The Medical director work ..
Job Information Humana Medical Director - Texas in San Juan Puerto Rico Description The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested ..
... whether services provided by other healthcare professionals are in agreement with ... whether services provided by other healthcare professionals are in agreement with ... organizations, and able to pass..
Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health episodic and per diem requests. The Medical Director provides medical interpretation and determinations whether ..
Job Information Humana UM Medical Director - Conviva in San Juan Puerto Rico Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve ..
Description The Senior Clinical Fraud and Waste Professional performs analysis of clinical investigations of allegations of fraudulent and abusive practices. The Senior Clinical Fraud and Waste Professional work assignments involve moderately ..
