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... 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..
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Description The Risk Adjustment Representative 2 conducts quality assurance audits of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other ..
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 ..
... 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 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..
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 ..
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 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 ..
