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The Human Resources Compliance Coordinator (HRCC) oversees and ensures HR compliance regarding work related injuries, unemployment claims, policy compliance, and Affirmative Action Plan. Provides support to the organization and assures work ..
Description The Quality Compliance Professional 2 completes annual quality ... reviews and research. The Quality Compliance Professional 2 work assignments are ... of action. Responsibilities The Quality Compliance Professional 2..
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 ..
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 ..
Description The Provider Contracting Executive initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Provider Contracting Executive works on problems ..
Description The DRG Validation Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM and PCS) to patient records. The Medical ..
Description The Senior Market Consultation/Partnership Professional promotes and improves the quality and measurement of care delivery programs with a market(s). The Senior Market Consultation/Partnership Professional work assignments involve moderately complex to ..
Job Code 2173916I Opportunities at Northern Light Health , in strategic partnership with Optum. Whether you are looking for a role in a clinical setting or supporting those who provide care, ..
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 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 ..
Job Information Centerwell Care Transition Liaison, Home Health Full Time in Portland Maine The Care Transition Liaison manages an assigned, limited number of key facility and/or physician accounts providing ongoing information ..
Description The Behavioral Health Medical Director makes determinations regarding prior authorization and retrospective reviews for inpatient and outpatient services to ensure that members receive clinically appropriate and medically necessary services. All ..
Description The Medical Director's primary responsibility is the review of medical authorizations or claims to determine the medical necessity of a given service or level of care. The Medical Director's work ..
Job Information Humana AVP, Stars and Risk Adjustment National Medical Director in Portland Maine Description The Healthcare Quality Reporting & Improvement (HQRI) organization is seeking a talented Physician executive that can ..
Job Information Humana AVP, MD, Stars and Risk Adjustment Clinical Strategy and Leadership in Portland Maine Description The Healthcare Quality Reporting & Improvement (HQRI) organization is seeking an AVP to lead ..
