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... Information Humana Medicaid Associate Director, Compliance Nursing in Vancouver Washington Description ... Washington 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 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 ..
**Providence is calling a Clinical Case Manager (LCSW) - Utilization Review Quality Management (1.0 FTE, Day) to Providence Office Park Portland in Portland, OR** **$5,000 Sign-on Bonus for external candidates and ..
... is calling a Safety/Environmental Health Manager - Risk Compliance And Safety (1.0 FTE, Days) ... are seeking a Safety/Environmental Health Manager - Risk Compliance And Safety that will be..
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 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 ..
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 ..
... 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..
Job Information Humana AVP, Stars and Risk Adjustment National Medical Director in Vancouver Washington Description The Healthcare Quality Reporting & Improvement (HQRI) organization is seeking a talented Physician executive that can ..
Job Information Centerwell RN Clinical Manager in Lake Oswego Oregon The ... Lake Oswego Oregon The Clinical Manager coordinates and oversees all direct ... to ensure documentation is in compliance..
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 ... Vancouver Washington Description The Care Manager, Telephonic Nurse 2 , in ... wellbeing of members. The Care Manager, Telephonic..
Job Information Humana AVP, MD, Stars and Risk Adjustment Clinical Strategy and Leadership in Vancouver Washington Description The Healthcare Quality Reporting & Improvement (HQRI) organization is seeking an AVP to lead ..