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... Home Advantage (YHA) Market Clinical Manager (MCM) will lead a team ... Assessments (IHWA). The Market Clinical Manager provides leadership, clinical management and ... practice providers. The Market Clinical..
... Information Humana Medicaid Associate Director, Compliance Nursing in Cincinnati Ohio Description ... Ohio Description The Associate Director, Compliance Nursing reviews utilization management activities ... and abuse. The Associate Director,..
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..
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 ..
... activities such as patient admission, regulatory reporting, billing, physician orders, lab ... treatment related data into systems.Ensures regulatory, compliance, and audit activities are accomplished ... and provides ongoing education,..
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..
Job Information Humana Care Manager, Telephonic Registered Nurse, (RN) 2 ... Cincinnati Ohio Description The Care Manager, Telephonic Nurse 2 , in ... wellbeing of members. The Care Manager, Telephonic..
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 ..
... the direction of the Pharmacy Manager or pharmacist, prepares, and files ... exercises independent judgment to ensure compliance and execution of all business ... equipment. In collaboration with Pharmacy..
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..
OverviewRehab Program Manager - ALF SettingnnRehab Program Manager position available to begin ASAPnFlorence, ... meetings that adhere to all regulatory requirements.u2022 Responsible for conducting performance ... Monitors and assists with..
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 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..
Job Information Humana AVP, MD, Stars and Risk Adjustment Clinical Strategy and Leadership in Cincinnati Ohio Description The Healthcare Quality Reporting & Improvement (HQRI) organization is seeking an AVP to lead ..
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 ..
Current UC employees must apply internally via SuccessFactors > http://bit.ly/UCEMPL Founded in 1819, the University of Cincinnati embarks upon its third century - building on the past and defining the future ..
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 ..
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 Cincinnati Ohio Description The Healthcare Quality Reporting & Improvement (HQRI) organization is seeking a talented Physician executive that can ..
