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... detecting and investigation of potential fraud and provide clinical guidance to ... reviewing of medical records for fraud, waste or abuse as well ... detecting and investigation of potential..
Job Information Humana Medicaid Associate Director, Compliance Nursing in Las Vegas Nevada Description The Associate Director, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and ..
Description Responsibilities The Associate Director for ACD Audit , at the director of the Director of Payment Integrity, will create and implement process improvement plans focused on the beneficiary and provider ..
Description Responsibilities The Care Manager, Behavioral Health 2 (BCBA) is responsible for the administration and monitoring of the Autism Care Demonstration (ACD) including coordination of services for ABA Therapy, benefits provided ..
Description Responsibilities Senior Care Manager, Behavioral Health (BCBA) This is a non-exempt position with responsibility for utilization management and clinical decision-making as outlined in the Autism Care Demonstration (ACD) defined in ..
Job Information Humana Fraud and Waste Investigator - Work ... is looking for an experienced Healthcare Investigator to join its industry ... have a passion for combating Fraud, Waste, and..
Description The Senior Clinical Fraud and Waste Professional performs analysis ... abusive practices. The Senior Clinical Fraud and Waste Professional work assignments ... factors. Responsibilities The Senior Clinical Fraud and..
Job Information Humana Genetic Counselor (Board Certified)-Remote/Virtual in US in Las Vegas Nevada Description Humana is seeking a Board Certified Genetic Counselor to join our Special Investigations Unit - Clinical Review ..
Description The Nurse Auditor 2 will work on the clinical research and development team with coders, clinicians and genetic counselors to develop, implement and maintain clinical lab audit concepts. The Nurse ..
Description The Supervisor, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Supervisor, Compliance ..
Description The Care Manager, Telephonic Behavioral Health 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward ..
