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Description The Care Manager, Telephonic Nurse 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 and ..
... live in market. Responsibilities The Clinical Documentation Specialist (CDS) follows state and federal ... information and medical records. The Clinical Documentation Specialist conducts medication reviews of charts ... to..
... and providers. The Director, Pharmacy Clinical Formulary and Medical Strategies requires ... specialty to develop and/or implement clinical strategies to mitigate cost while ... strategies. Responsibilities The Director, Pharmacy..
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 Senior Clinical Pharmacy Advisor - Trend, is ... team that helps translate the clinical into financial. The goals is ... Responsibilities include the following: Provide clinical and analytical..
Job Information Humana Physician - CenterWell - Atlanta, GA - College Park in Tampa Florida Description CenterWell Senior Primary Care, a subsidiary of Humana Inc., is the new brand for a ..
... reviews utilization management activities and documentation to ensure adherence to policies, ... and summarize findings for the clinical operational teams to initiate and ... include issues on absence of..
... will lead a team on non-clinical associates who support the coordination, ... associates who support the coordination, documentation and communication of medical services ... following: Oversight of Prior Authorization..
Description Responsibilities This role within the Autism Care Demonstration (ACD) Team, will work closely with Care Management leaders and Subject Matter Experts in the areas of Case Management, Utilization Management and ..
... resources, which may include national clinical guidelines, CMS policies and determinations, ... guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, ... of moderately complex to complex..
Description The Clinical Pharmacy Advisor lead, overseeing Humana ... team that helps translate the clinical into financial. The goals is ... key metrics and trend. Support clinical research integration activities..
Description Healthcare isn't just about health anymore. It's about caring for family, friends, finances, and personal life goals. It's about living life fully. At Conviva, a wholly-owned subsidiary of Humana, Inc., ..
Description The Compliance (UM) Lead conducts and summarizes compliance audits. The Compliance (UM) Lead works on problems of diverse scope and complexity ranging from moderate to substantial. Responsibilities The Compliance (UM) ..
Description At Conviva Care Solutions, we want to inspire people to live life their best healthy life. Conviva Care Solutions is a management services organization representing nearly 300 physician practices, 800 ..
Description CenterWell Senior Primary Care, a subsidiary of Humana Inc., is the new brand for a primary care medical group practice with centers open or opening in Florida, Georgia, Kansas, Louisiana, ..
Job Information Humana Physician - CenterWell - Atlanta, GA in Tampa Florida Description CenterWell Senior Primary Care, a subsidiary of Humana Inc., is the new brand for a primary care medical ..
Description The Risk Adjustment Coder ensures coding is accurate and properly supported by clinical documentation within the health record. Follows state and federal regulations as well as internal policies and guidelines ..
