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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 Dover Delaware Description ... Delaware Description The Associate Director, Compliance Nursing reviews utilization management activities ... and abuse. The Associate Director,..
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 ..
Caregiving is our Calling At Amedisys whether we're caring for patients directly or supporting those who do, each of us is a caregiver at heart. Every team member contributes to our ..
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 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 ..
... philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements. Ensure ... in accordance with all legal, compliance, and regulatory requirements and programs. Adheres..
Job Information Humana Care Manager, Telephonic Registered Nurse, (RN) 2 ... Dover Delaware Description The Care Manager, Telephonic Nurse 2 , in ... wellbeing of members. The Care Manager, Telephonic..
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 Humana AVP, Stars and Risk Adjustment National Medical Director in Dover Delaware 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 ..
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 Senior Compliance Professional ensures compliance with governmental requirements as they ... Medicaid State reporting. The Senior Compliance Professional work assignments involve moderately ... variable factors. Responsibilities The Senior Compliance..
Description The Bilingual Manager, Learning Facilitation , plans, coordinates, ... Grievances and Appeals Learning Facilitation Manager Oversee a team of instructors ... Update as process change for compliance and oversight..
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..
... the position of Assistant Nurse Manager. 5C (40 bed) Teaching Medical ... both units with the Nurse Manager and the other ANMs. THIS ... ROLE WILL SUPPORT THE NURSE..
Job Information Humana AVP, MD, Stars and Risk Adjustment Clinical Strategy and Leadership in Dover Delaware Description The Healthcare Quality Reporting & Improvement (HQRI) organization is seeking an AVP to lead ..
