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Description Responsibilities The Associate Director Medical/Financial Risk Evaluation leads a few powerful teams dedicated to reducing waste and abuse in the health care industry and its impacts on Humana. These teams ..
Description The Care Manager, Telephonic Behavioral Health 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward ..
... Director, Compliance Nursing reviews utilization management activities and documentation to ensure ... and to prevent and detect fraud, waste, and abuse. The Associate ... and quality performance and staffing..
Description The Payment Integrity Professional 2 uses technology and data mining, detects anomalies in data to identify and collect overpayment of claims. Contributes to the investigations of fraud waste and our ..
Description Humana's Claims Cost Management (CCM) organization is seeking a ... organization is seeking a Manager, Fraud & Waste to join the ... in the US. As the Fraud &..
... and clinical compliance, and case management. Serve as a Humana Military/Humana ... for quality standards, claims accuracy, fraud, and required clinical elements. Perform ... clinical elements. Perform telephonic case..
... Qualifications 3 plus years of healthcare fraud investigation experience 2 plus years ... knowledge and experience Experience in healthcare or in a managed care ... raw data and recommendations..
... customer experience, continuous improvement, change management, data integrity and process-level measurements. ... 10% Working with ACD Care Management operational leaders, lead development of ... objectives. Required Qualifications Experience in..
