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Description The Risk Adjustment Representative 2 conducts quality assurance audits of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other ..
... guidelines/procedures. Job Overview Humana At Home is a division of Humana ... Care Managers are work at home associates, working from a dedicated ... associates, working from a dedicated..
Description The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All ..
Description The Supervisor, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Supervisor, Compliance ..
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 ..
... American Board of Medical Specialty certification is psychiatry Preferred Qualifications Experience ... and/or special projects. Work at Home Guidance To ensure Home or Hybrid Home/Office associates' ability to work..
Job Information Humana Medical Director - Florida Medicaid in Glen Allen Virginia Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately ..
Job Information Humana UM Medical Director - Conviva in Glen Allen Virginia Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately ..
Job Information Humana Medical Director - Medicare Pharmacy Appeals in Glen Allen Virginia Description The Medical Director relies on clinical background and reviews Medicare drug requests. The Medical director work assignments ..
Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health episodic and per diem requests. The Medical Director provides medical interpretation and determinations whether ..
... Strategy Pharmacist - Work At Home in Glen Allen Virginia Description ... appropriate state Must have Board Certification Clinical experience in managed care ... Preferred Qualifications Board Certified Pharmacotherapy..
Job Information Humana Medicare Appeals and Grievance Medical Director in Glen Allen Virginia Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare ..
... Required Qualifications AAPC or AHIMA certification required (CPC-A, CPC, CCS, CCA) ... in good standing with the certification governing body Must be willing ... and some overtime Work At..
... degree Current and ongoing board certification in an approved ABMS Medical ... Lead Medical Director Work at Home Guidance To ensure Home or Hybrid Home/Office associates' ability to work..
Job Information Humana Medical Director - National Medicare Team in Glen Allen Virginia Description The Medical Director relies on medical background and reviews preauthorization requests for services. The Medical Director work ..
... Waste Investigator - Work At Home (Anywhere in the US) in ... or work outside of their home. If progressed to offer, you ... exemptions are available. Work at..
... Qualifications AAPC or AHIMA coding certification required; CPC, CPC-A, or CCS ... in good standing with the certification governing body Effective written and ... is in a Work At..
Description The Lead Behavioral Health Medical Director oversees the work of 2 Medical Directors who conduct clinical case reviews of the care received by members in an assigned market, member population, ..
... and Waste Investigator-- REMOTE/WORK AT HOME in Glen Allen Virginia Description ... or work outside of their home. If progressed to offer, you ... exemptions are available. Work at..
Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part C Line of Business. The Medical Director provides medical interpretation and determinations ..
