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Case Manager The candidate provides Child Support Services by managing a caseload to obtain results for customers that include but are not limited to establishing paternity and medical and child support ..
Description Healthcare isn't just about health anymore. ... of our members, and the healthcare industry. Responsibilities In this role, ... for the PCO University. Monitor medical performance and provide guidance..
Description The Medical Director relies on medical background and reviews health claims. ... and reviews health claims. The Medical Director work assignments involve moderately ... in-depth evaluation of variable factors...
... The Senior Professional collaborates with healthcare professionals, pharmacists, and other business ... functions to implement formulary and medical strategies for the Medicaid line ... The Senior Professional collaborates with..
Description The Behavioral Health Medical Director makes determinations regarding prior ... Humana coverage policies and determinations, medical necessity criteria, clinical reference materials, ... conferences, and other reference sources. Medical Directors..
Description The Medical Director relies on fundamentals of ... C Line of Business. The Medical Director provides medical interpretation and determinations whether services ... whether services provided by other healthcare..
Description The Manager, Medical Coding oversees the coding team that is reviewing inpatient records for appropriate coding to include ICD-10, CPT, and HCPCS. The Manager, Medical Coding works within specific guidelines ..
Description The Behavioral Health Medical Director responsible for behavioral health ... and/or operations. The Behavioral Health Medical Director work assignments involve moderately ... Government Business's (HGB) Behavioral Health Medical Director..
Description The Medical Coding Coordinator 2 will process and apply the appropriate Code Edit claim payment reductions and denials based on software recommendation. The Medical Coding Coordinator 2 reviews submitted medical ..
Description The Medical Director relies on medical background and reviews health claims. ... and reviews health claims. The Medical Director work assignments involve moderately ... factors. Responsibilities Job Profile The..
Description The Medical Director actively uses their medical background, experience, and judgement to ... conferences, and other reference sources. Medical Directors will learn Medicare and ... their daily work. Responsibilities..
... Director, Pharmacy Clinical Formulary and Medical Drug Strategies oversees and drives ... and drives the pharmacy and medical drug formulary strategies across all ... Director, Pharmacy Clinical Formulary and..
Description The Medical Director relies on medical background and reviews health claims. ... and reviews health claims. The Medical Director work assignments involve moderately ... of variable factors. Responsibilities The..
Description The Medical Director relies on medical background and reviews health claims. ... and reviews health claims. The Medical Director work assignments involve moderately ... of variable factors Responsibilities The..
Description The Medical Director relies on medical background and reviews health claims. ... and reviews health claims. The Medical Director work assignments involve moderately ... Government Business's (HGB) Behavioral Health..
Description The Medical Coding Coordinator 3 extracts clinical ... information from a variety of medical records and assigns appropriate procedural ... assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM,..
Description The Medical Director relies on fundamentals of ... and per diem requests. The Medical Director provides medical interpretation and determinations whether services ... whether services provided by other healthcare..
Description The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations for Humana's Kentucky Medicaid Plan. The Utilization ..
Description The Medical Director's primary responsibility is the ... responsibility is the review of medical authorizations or claims to determine ... or claims to determine the medical necessity of a..
... Stars and Risk Adjustment National Medical Director in Lancaster South Carolina ... Lancaster South Carolina Description The Healthcare Quality Reporting & Improvement (HQRI) ... nationally. This role relies on..
Description The Medical Coding Auditor extracts clinical information ... information from a variety of medical records and assigns appropriate procedural ... assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM,..
