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Description The Compliance Lead (Medicaid Contract Administrator) ensures ... Lead (Medicaid Contract Administrator) ensures compliance with governmental requirements, works on ... from moderate to substantial. The Compliance Lead (Medicaid Contract..
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 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 home health episodic and per diem requests. The Medical Director provides medical interpretation and determinations whether ..
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'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 ..
... Information Humana Medicaid Associate Director, Compliance Nursing in Lancaster South Carolina ... Carolina Description The Associate Director, Compliance Nursing reviews utilization management activities ... and abuse. The Associate Director,..
Job Information Humana AVP, Stars and Risk Adjustment National Medical Director in Lancaster South Carolina Description The Healthcare Quality Reporting & Improvement (HQRI) organization is seeking a talented Physician executive that ..
Job Information Humana Care Manager, Telephonic Registered Nurse, (RN) 2 ... South Carolina Description The Care Manager, Telephonic Nurse 2 , in ... wellbeing of members. The Care Manager, Telephonic..
Job Information Humana Compliance Lead - Illinois Medicaid in ... Lancaster South Carolina Description The Compliance Lead ensures compliance with governmental requirements. The Compliance Lead works on problems of .....
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 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, MD, Stars and Risk Adjustment Clinical Strategy and Leadership in Lancaster South Carolina Description The Healthcare Quality Reporting & Improvement (HQRI) organization is seeking an AVP to ..
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..
