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Description Responsibilities The Compliance Professional 2 has responsibilities for ... documentation for quality and clinical compliance with contract requirements as outlined ... ensure all providers are in compliance based on..
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 Care Manager, Behavioral Health (BCBA) in Green ... Description Responsibilities The Senior Care Manager, Behavioral Health (BCBA) is responsible ... auditing for quality and clinical compliance,..
Description The Behavioral Health Medical Director makes determinations regarding prior authorization and retrospective reviews for inpatient and outpatient services to ensure that members receive clinically appropriate and medically necessary services. All ..
Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires ..
Description The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All ..
Job Information Humana Senior Cloud Security Engineer (virtual remote) in Green Bay Wisconsin Description Responsibilities Our Department of Defense Contract requires U.S. citizenship for this position The Remote Senior Cloud Security ..
Description iCare is seeking an Associate Director, Medicaid Care Management who will lead teams of healthcare professionals responsible for care management for BadgerCare Plus and SSI Medicaid programs. The Associate Director, ..
Job Information Humana Manager, Compliance - Agent Investigation Unit in ... Green Bay Wisconsin Description The Manager, Compliance ensures compliance with governmental requirements. The Manager, Compliance works within specific guidelines..
Description The Manager, Compliance - Medicaid State Reporting ensures ... - Medicaid State Reporting ensures compliance with governmental requirements. The Manager, Compliance - Medicaid State Reporting works ... perks for..
... background and industry-standard clinical / coding guidance to ensure physician and ... position provides supportive clinical and coding expertise across the teams in ... those functions Serve as a..
Description The Manager, Risk Adjustment oversees coding educators and quality assurance audits ... and Medicaid Services (CMS). The Manager, Risk Adjustment works within specific ... schedules and goals. Responsibilities The..
Job Information Humana Associate Director, Provider Data Interoperability in Green Bay Wisconsin Description Humana's Provider Data and Medicaid Governance team is committed to effective and efficient business solutions for quality assurance ..
... Interoperability, 2) serve as a coding expert to manage escalations or ... acumen, and industry-standard clinical / coding guidance to ensure physician and ... position provides supportive clinical and..
Description The Manager, Compliance Nursing reviews utilization management activities ... fraud, waste, and abuse. The Manager, Compliance Nursing works within specific guidelines ... schedules and goals. Responsibilities The Manager, Compliance..
Description The Medical Director's primary responsibility is the review of medical authorizations or claims to determine the medical necessity of a given service or level of care. The Medical Director's work ..
Description Humana is a $90 billion (Fortune 40) market leader in integrated healthcare whose dream is to help people achieve lifelong well-being. As a company focused on the health and well-being ..
