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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 Birmingham Alabama Description ... Alabama Description The Associate Director, Compliance Nursing reviews utilization management activities ... and abuse. The Associate Director,..
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 ..
Job Information Centerwell RN Clinical Manager in Hoover Alabama The Clinical ... in Hoover Alabama The Clinical Manager coordinates and oversees all direct ... to ensure documentation is in compliance..
Job Information Humana AVP, MD, Stars and Risk Adjustment Clinical Strategy and Leadership in Birmingham Alabama Description The Healthcare Quality Reporting & Improvement (HQRI) organization is seeking an AVP to lead ..
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 ..
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 Manager, Compliance Nursing reviews utilization management activities ... fraud, waste, and abuse. The Manager, Compliance Nursing works within specific guidelines ... schedules and goals. Responsibilities The Manager, Compliance..
Job Information Humana AVP, Stars and Risk Adjustment National Medical Director in Birmingham Alabama Description The Healthcare Quality Reporting & Improvement (HQRI) organization is seeking a talented Physician executive that can ..
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 Care Manager, Telephonic Registered Nurse, (RN) 2 ... Birmingham Alabama Description The Care Manager, Telephonic Nurse 2 , in ... wellbeing of members. The Care Manager, Telephonic..
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 ..
