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... Information Humana Medicaid Associate Director, Compliance Nursing in Cincinnati Ohio Description ... Ohio Description The Associate Director, Compliance Nursing reviews utilization management activities ... and abuse. The Associate Director,..
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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 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 and ..
... within a context of regulatory compliance, and work is assisted by ... whether services provided by other healthcare professionals are in agreement with ... meeting departmental expectations, and meets..
Description The Principal Quality Leader will lead testing and ... Leader will lead testing and quality collaboration between Business and IT, ... tools and assure adherence to quality standards. Serves..
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 ..
... within a context of regulatory compliance, and work is assisted by ... whether services provided by other healthcare professionals are in agreement with ... departments, Humana colleagues and the..
Description The Director, Quality Improvement implements quality improvement programs for all lines ... and annual evaluation. The Director, Quality Improvement requires an in-depth understanding ... across departments. Responsibilities The Director,..
... on medical record documentation for quality and clinical compliance with contract requirements as outlined ... for this position . 75% Quality Monitoring Audits. Review and assess ... ensure all..
... Member Plan (EFMP), auditing for quality and clinical compliance, and case management. Serve as ... ABA treatment plans for policy compliance. Assist with analysis of necessary ... Review outcome..
Description Responsibilities The Compliance Professional 2 has responsibilities for ... on medical record documentation for quality and clinical compliance with contract requirements as outlined ... CPT Codes. KEY ACCOUNTABILITIES 95%..
... philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory ... procedures, and training and in compliance with regulations set forth by ... the FMCNA commitment to the..
Description The Pharmacy Claims Lead operationalizes and monitors Coordination of Benefits (COB) and subrogation claim processing logic and processes. Exercises independent judgment and decision making on managing staff, complex issues regarding ..
Description The Associate Director, Quality Improvement implements quality improvement programs for all lines ... annual evaluation. The Associate Director, Quality Improvement requires a solid understanding ... department(s). Responsibilities The Associate..
Description The Behavioral Health Parity Compliance Lead will play an integral ... of our Mental Health Parity Compliance Program. Responsibilities This role is ... Healthy Horizons Mental Health Parity Compliance..
Description The Dental Director (part-time) provides dental interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Responsibilities The ..
... performing complex tasks related to compliance with accreditation standards across multiple ... performing complex tasks related to compliance with accreditation standards across multiple ... the development and implementation of..
... physicians, physician groups, and integrated healthcare delivery systems throughout the country. ... delivery systems throughout the country. Healthcare isn't just about health anymore. ... of our members, and the..
... relationships with physicians, providers and healthcare systems in order to maintain ... maintain and improve financial and quality performance within the contracted working ... as financial performance, incentive programs,..
Description The Associate Director, Utilization Management Nursing uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, ..
... business reviews in accordance with compliance requirements advise Commercial Product of ... recommend opportunities to optimize vendor quality Facilitate the measurement of success ... and/or service level oversight including..
Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires ..
