Managed Care Compliance Jobs in Springfield

... best and most appropriate treatment, care or services for members. Coordinates ... other parties to facilitate optimal care and treatment. Decisions are typically ... and processes necessary to maintain..

... best and most appropriate treatment, care or services for members. Coordinates ... other parties to facilitate optimal care and treatment. Decisions are typically ... and processes necessary to maintain..

At Nova our mission is To Provide Individuals and Families Opportunity for Positive Change. We accomplish this mission by our vision, To provide specialized, evidenced-based treatment, which is continuously responsive to ..

Job Information Humana Quality Compliance Professional in Springfield Ohio Description ... Springfield Ohio Description The Quality Compliance Professional 2 completes annual quality ... reviews and research. The Quality Compliance Professional..

... and value, while also managing compliance with network requirements, including network ... Department of Health of Medicaid Managed Care Contract. The Lead will support ... proactively identify network issues,..

... fraud, waste, and abuse (FWA) compliance program to prevent and detect ... out the provisions of the compliance plan, including FWA policies and ... Oversee internal investigations of FWA..

Job Information Humana Storage Administrator- Storage and Backup in Springfield Ohio Description At Humana we are committed to helping people live healthy and happy through personalized care. Following the same mantra, ..

Job Information Humana Quality Improvement Coordinator in Springfield Ohio Description The Quality Improvement Coordinator 3 assists in administering and monitoring quality improvement and compliance processes for the Ohio Medicaid program. The ..

Job Information Humana Associate Director, Provider Data Interoperability in Springfield Ohio Description Humana's Provider Data and Medicaid Governance team is committed to effective and efficient business solutions for quality assurance and ..

Job Information Humana Care Manager, Registered Nurse, RN - ... Springfield Ohio Description The Field Care Manager assesses and evaluates member's ... with resources appropriate for the care and wellbeing..

Description The Project Manager manages all aspects of a project, from start to finish, so that it is completed on time and within budget. The Project Manager work assignments are varied ..

Job Information Humana Sr. DevOps Cloud Engineer in Springfield Ohio Description Do you thrive on working on leading edge technology such as AKS and Kubernetes? Do you embrace the DevOps workstyle ..

Job Information Humana Care Manager, Licensed Behavioral Health Professional ... Springfield Ohio Description The Field Care Manager, Behavioral Health 2 (Care Manager, Behavioral Health) assesses and ... with resources appropriate..

Description Humana is a $90 billion (Fortune 40) market leader in integrated healthcare with a clearly defined purpose to help people achieve lifelong well-being. As a company focused on the health ..

... plan related to claims Ensure compliance with South Carolina's Managed Care Contractual requirements for provider relations, ... working with or in health care administration setting Exceptional relationship management .....

Description Humana is a $90 billion (Fortune 40) market leader in integrated healthcare with a clearly defined purpose to help people achieve lifelong well-being. As a company focused on the health ..

... to increasing patient access to care, lowering costs and improving the ... and improving the quality of care. Millions of times a day, ... shaping the future of health..

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 The Senior Quality Compliance Nurse Professional is an integral ... projects. Responsibilities The Senior Quality Compliance Nurse Professional will partner with ... Department of Medicaid and other Managed Care..

... across members, providers, agents, clinical, care management, pharmacy, and other units. ... new benefits launch, provider find care, provider management self-service, and provider ... management. Innovate on clinical and..

... fraud, waste, and abuse (FWA) compliance program to prevent and detect ... out the provisions of the compliance plan, including FWA policies and ... Oversee internal investigations of FWA..

Job Information Humana Care Guide - Physical Health in ... in Springfield Ohio Description The Care Guide (Care Coach 1) assesses and evaluates ... with resources appropriate for the care..

Job Information Humana Director, Care Delivery and EMR/EHR Technology in ... IT business initiatives specific to care delivery technology and the core ... capabilities interrelate across Humana's Primary Care segment,..