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... for: Sr. Project Manager- PCI Compliance Title: Sr. Project Manager- PCI ... Title: Sr. Project Manager- PCI Compliance Location: Owings Mills, MD Duration: ... assignments and deliverables • Reviews..
Description Humana Military is the Managed Care Support Contractor (MCSC) for the Department of Defense (DoD) charged with administering the TRICARE health plan in the East Region. While the contract is ..
... Information Humana Medicaid Associate Director, Compliance Nursing in Bethesda Maryland Description ... Maryland Description The Associate Director, Compliance Nursing reviews utilization management activities ... and abuse. The Associate Director,..
... record content analysis to ensure compliance with requirements of the TRICARE ... of medical records to ensure compliance with TRICARE contractual requirements for ... records to ensure that a..
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 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 ..
... 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 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 ..
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..
... 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 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%..
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 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 ..
... Nurse, to ensure provision of quality patient care on a daily ... the FMCNA commitment to the Quality Enhancement Program (QEP) and CQI ... patients will achieve the FMCNA..
... 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..
... 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..
... 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..
... 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..
