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Description The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within ..
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Description The Quality Compliance Professional 2 completes annual quality reviews and research. The Quality Compliance Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate ..
Job Information Humana Senior Provider Contracting Professional - Remote (EST Hours) in Columbia Tennessee Description The Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital, and/or other provider contracts and ..
Description The Provider Contracting Executive initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Provider Contracting Executive works on problems ..
Description The Behavioral Health Market Development Advisor provides support to assigned health plan and/or specialty companies relative to Medicare/Medicaid/TRICARE/Employer Group product implementation, operations, contract compliance, and federal contract application submissions. The ..
Description The Manager, Risk Adjustment oversees coding educators and quality assurance audits of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS). ..
Job Information Humana Quality Improvement Coordinator in Columbia Tennessee Description The Quality Improvement Coordinator 3 assists in administering and monitoring quality improvement and compliance processes for the Ohio Medicaid program. The ..
PURPOSE AND SCOPE: The Credentialing Specialist is responsible for verifying submitted Credentialing documentation. for all specialties that provide services to the organization's members. The Credentialing Specialist incumbent will meet all credentialing ..
... direction of a RN in compliance with the state's Nurse Practice ... any applicable licensure/certification requirement, applicable healthcare standards, governmental laws and regulations, ... manager(s), other members of the..
Description Humana is a $90 billion (Fortune 40) market leader in integrated healthcare with a clearly defined purpose to help people achieve lifelong well-being. As a company focused on the health ..
Description Senior Compliance Professional ensures compliance with governmental requirements as they ... Medicaid State reporting. The Senior Compliance Professional work assignments involve moderately ... variable factors. Responsibilities The Senior Compliance..
... procedures for local and state compliance. Essential Functions: Provides oversight of ... 5 years previous experience in healthcare, preferably rehabilitation experience Prior experience ... a different level. Job :..
