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Description Responsibilities The Associate Director Medical/Financial Risk Evaluation leads a few powerful teams dedicated to reducing waste and abuse in the health care industry and its impacts on Humana. These teams ..
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 ..
... Director, Compliance Nursing reviews utilization management activities and documentation to ensure ... and to prevent and detect fraud, waste, and abuse. The Associate ... and quality performance and staffing..
Description The Manager, Fraud and Waste, Genetic Counseling provides ... and abusive practices. The Manager, Fraud and Waste, Genetic Counseling works ... and goals. Responsibilities The Manager, Fraud and Waste,..
Department: FRYS Pharmacy Position Type: Employee Position Reports To: Store Management/Pharmacy Coordinator Position Supervises: N/A Pay Level: FLSA Status: Non-Exempt POSITION SUMMARY: To replace or fill-in pharmacy shifts on an as ..
... The Compliance Nurse reviews utilization management activities and documentation to ensure ... and to prevent and detect fraud, waste, and abuse. The Compliance ... plus Previous experience in utilization..
Department: FRYS Pharmacy Post End Date: Position Type: Employee Position Reports To: Pharmacy Manager/Store Management/Pharmacy Coordinator Position Supervises: N/A Pay Level: FLSA Status: Non-Exempt POSITION SUMMARY: To assist in directing the ..
Description The Associate Director, Payment Integrity uses technology and data mining, detects anomalies in data to identify and collect overpayment of claims. Contributes to the investigations of fraud waste and our ..
Description The Compliance Nurse 2 reviews medical management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Compliance Nurse ..
... Supervisor, Compliance Nursing reviews utilization management activities and documentation to ensure ... and to prevent and detect fraud, waste, and abuse. The Supervisor, ... solve basic problems; collaborates with..
Company Name: Fry's Food Stores Position Type: Employee FLSA Status: Non-Exempt POSITION SUMMARY: Create an outstanding patient experience through exceptional service and patient care. Establish and maintain a safe and clean ..
... and clinical compliance, and case management. Serve as a Humana Military/Humana ... for quality standards, claims accuracy, fraud, and required clinical elements. Perform ... clinical elements. Perform telephonic case..
Job Information Humana Manager, Fraud and Waste-Remote US in Phoenix ... Phoenix Arizona Description The Manager, Fraud and Waste conducts investigations of ... and abusive practices. The Manager, Fraud and..
Description The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Compliance Nurse ..
Department: FRYS Pharmacy Position Type: Employee Position Reports To: Pharmacy Manager or Pharmacist on Duty/Store Management Position Supervises: N/A Pay Level: FLSA Status: Non-Exempt POSITION SUMMARY: Create an outstanding patient experience ..
... position with responsibility for utilization management and clinical decision-making as outlined ... clinical information in various medical management systems. The associate understands department, ... limited to: 70% Performing utilization..
... Qualifications 3 plus years of healthcare fraud investigation experience 2 plus years ... knowledge and experience Experience in healthcare or in a managed care ... raw data and recommendations..
Description Humana's Claims Cost Management (CCM) organization is seeking a ... organization is seeking a Manager, Fraud & Waste to join the ... in the US. As the Fraud &..
Description The Payment Integrity Professional 2 uses technology and data mining, detects anomalies in data to identify and collect overpayment of claims. Contributes to the investigations of fraud waste and our ..
