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... to be recognized as the healthcare provider and the employer of ... to prevent them in the Quality Improvement/Innovation - Identifies and challenges ... efforts; contributes new ideas. Ethics..
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... 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..
... works within a framework of compliance expectations leading to significant variabilities ... advocate environment focused on high quality outcomes versus activities. Our department ... of their care. We value..
... 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..
... procedures, and training and in compliance with regulations set forth by ... the FMCNA commitment to the Quality Enhancement Program (QEP) and CQI ... patients will achieve the FMC..
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 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..
... is committed to providing personalized, high-quality primary care combined with an ... based care provider focused on quality of care for the patients ... Nurse, MA, Behavioral health specialist,..
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 ..
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 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 ..
... 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..
... is committed to providing personalized, high-quality primary care combined with an ... based care provider focused on quality of care for the patients ... nurses, MAs, behavioral health specialists,..
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 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%..
... of services provided by other healthcare professionals in compliance with review policies, procedures, and ... whether services provided by other healthcare professionals are in agreement with ... meeting departmental..
... Information Humana Medicaid Associate Director, Compliance Nursing in Salem Oregon Description ... Oregon Description The Associate Director, Compliance Nursing reviews utilization management activities ... and abuse. The Associate Director,..
... 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..
