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Description The RN, Compliance Nurse 2 reviews utilization management ... waste, and abuse. The RN Compliance Nurse 2 work assignments are ... of action. Responsibilities The RN Compliance Nurse 2..
Description The Quality Compliance Professional 2 completes annual quality reviews and research. The Quality Compliance Professional 2 work assignments are ... courses of action. Responsibilities The Quality Compliance Professional 2..
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... all utilization reviews are in compliance with the terms of the ... procedural and Florida Agency for Healthcare Administration (ACHA). Ensure adoption and ... contract changes and/or updates. Maintain..
... closely with physicians, team members, Quality, Compliance, partners at Enterprise and leadership ... to identify and deliver high quality and accurate risk adjustment coding. ... work experience with Coding..
FLDOH-1240 Contractor will perform the following tasks in the time and manner specified: Develop user requirement documents, design documents and screen presentations based on user requirements, user input and feedback as ..
Description The Manager, Risk Adjustment oversees coding educators and quality assurance audits of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS). ..
Description Humana Healthy Horizons in Florida is seeking an Associate Director, Care Management leads teams of nurses and behavior health professionals responsible for care management. The Associate Director, Care Management requires ..
Job Information Humana Quality Improvement Coordinator in Tallahassee Florida ... in Tallahassee Florida Description The Quality Improvement Coordinator 3 assists in ... assists in administering and monitoring quality improvement and..
... effective performance and delivery of quality home care services, and is ... to ensure documentation is in compliance with regulatory agencies and requirements ... are completed timely and in..
... direction of a RN in compliance with the state's Nurse Practice ... any applicable licensure/certification requirement, applicable healthcare standards, governmental laws and regulations, ... manager(s), other members of the..
Description Humana Healthy Horizons in Florida is seeking an Associate Director, Care Management who will lead teams of nurses and behavior health professionals responsible for care management. The Associate Director, Care ..
Description The Grievances & Appeals Professional 2 manages client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. The Grievances & Appeals ..
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 ..
