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Description The Pre-Authorization Behavioral Health Professional 2 reviews prior authorization requests for appropriate care and setting, follows guidelines and policies, and approves services or forwards requests as needed. The Pre-Authorization Behavioral ..
... through TRICARE and other military healthcare programs. High-quality service, cost-effective platforms, ... Ensure adherence to policies and performance standards in accordance with the ... participate in Care Management quality..
... guides, scripts, use case scenarios, performance support, mobile learning and process ... developing training curriculum, materials, job performance aids and programs to meet ... effective learning objectives and coordinates..
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 ..
... development and implementation of quality improvement interventions and audits and assists ... priorities Commitment to continuous process improvement Exceptional verbal and written communication ... minimum standard speed for optimal..
... requirements and provide for continuous improvement. You can be a part ... mission of supporting the TRICARE healthcare program for our nation's military. ... enables cloud to provide optimal..
Job Information Humana Director, Behavioral Health Strategy in Riverton Wyoming Description The Director, Behavioral Health (DBH) will ensure that populations served by Humana Healthy Horizons have access to quality care for ..
Description The RN Clinical team is looking for a dynamic Registered Nurse to join the team working remote anywhere in the US or in Louisville, KY! We are looking for someone ..
Description The Health Information Management Professional 2 ensures data integrity for claims errors. The Health Information Management Professional 2 work assignments are varied and frequently require interpretation and independent determination of ..
Job Information Humana Senior Care Manager, Behavioral Health (BCBA) in Riverton Wyoming Description Responsibilities The Senior Care Manager, Behavioral Health (BCBA) is responsible for the administration and monitoring of the Autism ..
... the project; monitors progress and performance against the project plan; takes ... completing projects Monitor progress and performance against the project plans and ... Qualifications 3-5 years of relevant..
... all levels and drive increased performance. Perform and monitor routine audits ... audits to ensure successful quality performance outcomes and compliance standards Develop ... plan of action for process..
Description The Health Information Management Professional ensures data integrity for claims errors. The Health Information Management Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate ..
... social determinants and obtaining timely healthcare. The Lead Medical Director provides ... of services provided by other healthcare professionals in compliance with review ... with review policies, procedures, and..
Job Information Humana Quality Improvement Program Lead (National Medicaid Quality) ... Horizons is seeking a Quality Improvement Program Lead who will be ... Humana Healthy Horizon's National Quality Improvement (QI)..
... encounter data, submission requirements and performance metrics per regulatory and health ... for error resolution, follow-up and performance monitoring. Participate in resolving encounter ... Qualifications Bachelor's degree in a..
Description The Senior Security Professional protects the organization's employees, properties, and all items of value on premises from any preventable harm or danger. The Senior Security Professional work assignments involve moderately ..
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 ..
... of Humana Healthy Horizon's National Improvement strategy and operating model for ... Health Quality management model and improvement strategy for the Medicaid line ... quality measurement data collection and..
