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... Director, Pharmacy Clinical Formulary and Medical Strategies requires a broad understanding ... execute on the formulary and medical drug strategies. Responsibilities The Director, ... Director, Pharmacy Clinical Formulary and..
Description The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. The ..
Description The Medical Director relies on medical background and reviews health claims. ... and reviews health claims. The Medical Director work assignments involve moderately ... of variable factors. Responsibilities The..
Description Job Description Summary The Medical Director relies on medical background and reviews health claims. ... and reviews health claims. The Medical Director work assignments involve moderately ... factors. Responsibilities..
... review team is seeking a Medical Coding Auditor with a special ... review information provided in the medical records they must understand what each ... it should represented in..
Description The Risk Adjustment Coder ensures coding is accurate and properly supported by clinical documentation within the health record. Follows state and federal regulations as well as internal policies and guidelines ..
Description The Medical Director relies on medical background and reviews health claims. ... and reviews health claims. The Medical Director work assignments involve moderately ... East Coast hours Responsibilities The..
... coordination, documentation and communication of medical services and/or benefit administration determinations. ... in reviewing actual and proposed medical care and services against established ... against established CMS and Humana..
... Information Humana Manager, Pharmacy and Medical Trend in Dover Delaware Description ... drug trends, both pharmacy and medical, as well as the impact ... Humana profitability. Responsibilities Lead our..
Job Information Humana Fraud and Waste Investigator - Work At Home (Anywhere in the US) in Dover Delaware Description Humana is looking for an experienced Healthcare Investigator to join its industry ..
Description The Medical Director relies on medical background and reviews health claims. ... and reviews health claims. The Medical Director work assignments involve moderately ... East Coast hours. Responsibilities The..
Remote Inpatient Coding Opportunity – Full-time/Director Hire Requirements: 3+ years of Inpatient Coding, Auditing experience preferred Credentials: CCS, RHIT, or RHIA Required Reviews and evaluates hospital inpatient medical record documentation to ..
Description The Medical Director actively uses their medical background, experience, and judgement to ... and other sources of expertise. Medical Directors will learn Medicare and ... in their daily work...
Description The Fraud Investigation Technician 2 conducts investigations of allegations of fraudulent and abusive practices. The Fraud Investigation Technician 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. ..
Job Information Humana UM Medical Director - Conviva in Dover ... in Dover Delaware Description The Medical Director relies on medical background and reviews health claims. ... and reviews health..
Description The Medical Director actively uses their medical background, experience, and judgement to ... conferences, and other reference sources. Medical Directors will learn Medicare and ... daily work. Responsibilities Job..
Description Risk Adjustment Coders are responsible for reviewing medical records, completing multiple audits, and special projects. Associates in this role work collaboratively with other departments. Responsibilities The Risk Adjustment Coder ensures ..
Description The UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on ..
Wentworth-Douglass Hospital, an affiliate of Mass General Brigham, is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and ..
Job Information Humana Genetic Counselor (Board Certified)-Remote/Virtual in US in Dover Delaware Description Humana is seeking a Board Certified Genetic Counselor to join our Special Investigations Unit - Clinical Review team ..
Job Information Humana Senior Fraud and Waste Investigator-- REMOTE/WORK AT HOME in Dover Delaware Description Humana is looking for an experienced Senior Healthcare Investigator to join its industry leading Special Investigations ..
Description iCare is seeking an Enrollment Specialist who will support the iCare enrollment processing duties for all lines of business including Medicare, Medicaid, Family Care Partnership (FCP) and BadgerCare Plus. Responsibilities ..