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... position with responsibility for utilization management oversight and clinical decision-making as ... it specifically relates to Utilization Management (UM), addressing treatment needs of ... will be responsible for workload..
... 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..
... 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..
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..
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 Healthcare isn't just about health anymore. ... of our patients, and the healthcare industry as a whole. The ... Compliance Nurse 2 reviews utilization management activities and documentation to..
... 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..
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 ..
Description The Senior Compliance Nurse reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Senior Compliance ..
