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... requirements and criteria to ensure compliance with programmatic requirements Engage leadership ... programs and procedures to ensure compliance with state and federal regulations; ... utilization, and approval scenarios Recommend..
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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 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 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 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 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 ..
... 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..
... 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..
... Information Humana Medicaid Associate Director, Compliance Nursing in Tulsa Oklahoma Description ... Oklahoma Description The Associate Director, Compliance Nursing reviews utilization management activities ... and abuse. The Associate Director,..
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 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 ..
... 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..
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 ..
... 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 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 ..
... 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..
