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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 Metairie Louisiana Description The Associate Director, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations ..
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 This role has responsibility for the oversight and monitoring of the Autism Care Demonstration (ACD) team performance to ensure compliance with contract and complex ACD policy requirements as defined by ..
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 Senior Compliance Nurse reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Senior Compliance ..
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..
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 ..
Job Information Humana Senior Fraud and Waste Investigator-- REMOTE/WORK AT ... looking for an experienced Senior Healthcare Investigator to join its industry ... have a passion for combating Fraud, Waste,..
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..
Job Information Humana Genetic Counselor (Board Certified)-Remote/Virtual in US in Metairie Louisiana Description Humana is seeking a Board Certified Genetic Counselor to join our Special Investigations Unit - Clinical Review team ..
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 ..
Description The Louisiana Medicaid Pharmacy Lead monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders. Utilizes broad understanding of managed care and PBM knowledge to develop, ..
... Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Centers ... legal agreements where applicable, prevent fraud or potentially illegal activities, maintain ... legal agreements where applicable, prevent..
Job Information Humana Senior Care Manager, Behavioral Health (BCBA) in Metairie Louisiana Description Responsibilities The Senior Care Manager, Behavioral Health (BCBA) is responsible for the administration and monitoring of the Autism ..
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 ..
