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... in process consulting to support compliance within the Healthcare Services (HCS) organization. As a ... (HCS) organization. As a HCS Compliance & Risk Management Professional, you ... effectiveness and..
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Description Humana Military is the Managed Care Support Contractor (MCSC) for the Department of Defense (DoD) charged with administering the TRICARE health plan in the East Region. While the contract is ..
Description The Behavioral Health Clinical Advisor (Care Manager, Telephonic Behavior Health 2) will audit CPT (Current Procedural Terminology) codes to ensure correct billing under TOM (TRICARE Operations Manual) policies in accordance ..
Description The Compliance Nurse 2 reviews utilization management ... fraud, waste, and abuse. The Compliance Nurse 2 work assignments are ... courses of action. Responsibilities The Compliance Nurse 2- Auditor..
Description The RN, Compliance Nurse 2 reviews utilization management ... waste, and abuse. The RN Compliance Nurse 2 work assignments are ... of action. Responsibilities The RN Compliance Nurse 2..
Description The Director of Health Services for National Medicaid Clinical Operations utilizes clinical skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Director, Health ..
... Information Humana Medicaid Associate Director, Compliance Nursing in Tampa Florida Description ... Florida Description The Associate Director, Compliance Nursing reviews utilization management activities ... and abuse. The Associate Director,..
Job Information Humana Associate Director Utilization Management in Tampa Florida Description Come join our team. We are looking for an Associate Director, Utilization Management to utilize clinical nursing skills to support ..
Description The Compliance Manager ensures compliance with governmental requirements. The Compliance Manager works on problems of ... moderate to substantial. Responsibilities The Compliance Manager develops and implements compliance policies and..
Description The Senior Claims Process & Policy Professional processes new insurance policies, modifications to existing policies, and claims forms. The Senior Claims Process & Policy Professional work assignments involve moderately complex ..
Description Responsibilities The Utilization Management Nurse 2 will be responsible for performing clinical audits on medical record documentation for quality and clinical compliance with contract requirements as outlined in the Autism ..
Description The Home Compliance & Risk Management Lead contributes ... strategy by supporting risk and compliance initiatives across Home Solutions teams ... Home Solutions teams within the Healthcare Services organization...
Description The Behavioral Health Parity Compliance Lead will play an integral ... of our Mental Health Parity Compliance Program. Responsibilities This role is ... Healthy Horizons Mental Health Parity Compliance..
Description Responsibilities The Associate Director for ACD Audit , at the director of the Director of Payment Integrity, will create and implement process improvement plans focused on the beneficiary and provider ..
Description The Senior Risk Management Professional will be responsible for managing third party risk management (TPRM) work streams to support Humana's overall TPRM Program. Responsibilities include risk identification, data analysis, process ..
Description The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g. CPT) to patient records. The Medical Coding Auditor ..
