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... TRICARE line of business. Meet contract deliverables and performance guarantees while ... developmental plans at a 95% compliance rate for Supervisors and above; ... HGB / Humana brand Meet..
Description The Care Manager, Telephonic Behavioral Health 2 , ... wellbeing of members. The Care Manager, Telephonic Behavioral Health 2 work ... of action. Responsibilities The Care Manager, Telephonic Behavioral..
... timely and accurate implementation of Government supplied or directed fee schedules, ... and surveillance techniques to ensure compliance with government regulations. In collaboration with other ... responded to as..
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..
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 ..
... within a context of regulatory compliance, and work is assisted by ... include national clinical guidelines, Humana contract language, Humana coverage policies and ... by other healthcare professionals in..
... of variable factors. Responsibilities Humana Government Business's (HGB) Behavioral Health Medical ... Management (DM), population health management, contract compliance, quality improvement, and pilot/value-based payment ... HGB policy development to..
Job Information Humana Director, Informatics in Portland Maine Description The Director, Informatics coordinates with other analytics, IT and business areas across the organization to ensure work is completed with insights from ..
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 Manager, Compliance - Agent Investigation Unit in ... in Portland Maine Description The Manager, Compliance ensures compliance with governmental requirements. The Manager, Compliance works within specific guidelines..
Description Responsibilities The Compliance Professional 2 has responsibilities for ... documentation for quality and clinical compliance with contract requirements as outlined in the ... timely and in accordance with contract..
Description The Director, IT Compliance audits the most complex new ... information systems procedures are in compliance with corporate standards. The Director, ... corporate standards. The Director, IT Compliance requires..
Job Information Humana Senior Care Manager, Behavioral Health (BCBA) in Portland ... Description Responsibilities The Senior Care Manager, Behavioral Health (BCBA) is responsible ... auditing for quality and clinical compliance,..
Job Information Humana Senior Compliance Professional-Remote/Virtual in US in Portland ... Portland Maine Description The Senior Compliance Professional ensures compliance with governmental requirements. The Senior ... with governmental requirements. The..
Job Information Humana Senior Compliance Professional - Medicaid State Reporting ... Portland Maine Description The Senior Compliance Professional ensures compliance with governmental requirements. The Senior ... with governmental requirements. The..
Description The Contract Services team is part of ... reduce risk. Responsibilities The Senior Contract Management Professional is an experienced ... as the primary and/or secondary Contract Manager aligned to..
Description The Compliance Professional 2 ensures compliance with governmental requirements. The Compliance Professional 2 work assignments are ... courses of action. Responsibilities The Compliance Professional 2 develops and implements .....
Description Responsibilities The Care Manager, Behavioral Health 2 (BCBA) is ... auditing for quality and clinical compliance, and case management. Serve as ... ABA treatment plans for policy compliance. Assist..
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 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..
