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Description The Manager, Care Management leads teams of ... responsible for care management. The Manager, Care Management works within specific ... you succeed, we succeed! The Manager, Care Management oversees..
Description The Manager, Utilization Management Nursing utilizes clinical ... and/or benefit administration determinations. The Manager, Utilization Management Nursing works within ... you succeed, we succeed! The Manager, Utilization Management Nursing..
... Information Humana Medicaid Associate Director, Compliance Nursing in Anchorage Alaska Description ... Alaska Description The Associate Director, Compliance Nursing reviews utilization management activities ... and abuse. The Associate Director,..
**Providence is calling a Team Manager Nurse Family Partnership (Home Health ... Assist the Director and Finance Manager in the preparation of annual ... System Quality Improvement plans in compliance..
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 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 Humana Medicare Appeals and Grievance Medical Director in Anchorage Alaska Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part ..
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 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 Responsibilities The Compliance Professional 2 has responsibilities for ... documentation for quality and clinical compliance with contract requirements as outlined ... ensure all providers are in compliance based on..
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 ..
... a Registered Nurse (RN) Clinical Manager (5 North Medical Oncology, Day-Shift, ... patient care is delivered in compliance to standards utilizing cost-effective methods. ... Services Standards of Service Excellence..
Job Information Humana UM Medical Director - Conviva in Anchorage Alaska 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 - Medicare Pharmacy Appeals in Anchorage Alaska Description The Medical Director relies on clinical background and reviews Medicare drug requests. The Medical director work assignments involve ..
