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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 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 ..
... all utilization reviews are in compliance with the terms of the ... procedural and Florida Agency for Healthcare Administration (ACHA). Ensure adoption and ... contract changes and/or updates. Maintain..
Description Humana Healthy Horizons in Florida is seeking an Associate Director, Care Management leads teams of nurses and behavior health professionals responsible for care management. The Associate Director, Care Management requires ..
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 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). ..
FLDOH-1240 Contractor will perform the following tasks in the time and manner specified: Develop user requirement documents, design documents and screen presentations based on user requirements, user input and feedback as ..
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..
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 Grievances & Appeals Professional 2 manages client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. The Grievances & Appeals ..
Job Information Humana Quality Improvement Coordinator in Tallahassee Florida Description The Quality Improvement Coordinator 3 assists in administering and monitoring quality improvement and compliance processes for the Ohio Medicaid program. The ..
Description Humana Healthy Horizons in Florida is seeking an Associate Director, Care Management who will lead teams of nurses and behavior health professionals responsible for care management. The Associate Director, Care ..
Job Information Humana Senior Provider Contracting Professional - Remote (EST Hours) in Tallahassee Florida Description The Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital, and/or other provider contracts and ..
About the POSITION: DDS/DMD needed for Practice in Tallahassee, FL - established office, they will take someone with 1-2 years' experience; will work with other Dentists and strong support staff. It ..
Description The Community Health Worker contributes to the administration of Care Management and Utilization Management. The individual in this role provides non-clinical support to the assessment and evaluation of member's needs ..
**Company :**Highmark Inc.**Job Description :****JOB SUMMARY**This job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs (MA and ACA), using skills including but not ..
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 ..
TRS Healthcare is seeking an experienced Progressive ... 13 weeks Pay: $2604.6/Week TRS Healthcare is seeking a Registered Nurse ... Life Support certification About TRS Healthcare: TRS Healthcare is a..
... to ensure documentation is in compliance with regulatory agencies and requirements ... are completed timely and in compliance with Medicare regulations. Coordinates communication ... policies and procedures to ensure..
... 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 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 ..
