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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 ..
... 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..
AdvantageCare Rehabilitation is now hiring a Nurse Consultant Clinical Reimbursement Specialist to oversee our facilities in Western PA. This is a home based position, but travel throughout Western, PA and surrounding ..
Job Information Humana Medicare Appeals and Grievance Medical Director in Pittsburgh Pennsylvania Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part ..
... 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..
... Strategy Pharmacist - Work At Home in Pittsburgh Pennsylvania Description Responsibilities ... appropriate state Must have Board Certification Clinical experience in managed care ... Preferred Qualifications Board Certified Pharmacotherapy..
Description Job Description Summary 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 ..
We have an immediate opportunity for Registered Nurses. General Summary: The Registered Nurse (RN) assesses, plans, implements, evaluates and provides nursing care to assigned patients utilizing the nursing process to facilitate ..
... 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..
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 ..
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 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, ..
... prepare the patient for self, home or further professional care. The ... Registered Nurse program is required. Licensure/Certification: Current Registered Nurse license in ... practicing is required. Current BLS..
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 ..
Job Information Humana Medical Director - Medicare Pharmacy Appeals in Pittsburgh Pennsylvania Description The Medical Director relies on clinical background and reviews Medicare drug requests. The Medical director work assignments involve ..
Job Information Humana UM Medical Director - Conviva in Pittsburgh Pennsylvania Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..
Job Information Humana Medical Director - National Medicare Team in Pittsburgh Pennsylvania Description The Medical Director relies on medical background and reviews preauthorization requests for services. The Medical Director work assignments ..
Job Information Humana Medical Director - Florida Medicaid in Pittsburgh Pennsylvania Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..
... and Waste Investigator-- REMOTE/WORK AT HOME in Pittsburgh Pennsylvania Description Humana ... or work outside of their home. If progressed to offer, you ... exemptions are available. Work at..
... 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..
