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... integration performance, network adequacy, performance improvement projects, and surveys related to ... work closely with the Performance/Quality Improvement Coordinator, Behavioral Health Network Director, ... of experience in managing behavioral..
... every aspect of the claims process, including initial claim payment, claim ... the development and implementation of process improvement projects. Ensures that appropriate concurrent ... claims management experience in..
Description The Claims Research & Resolution Professional 2 manages claims operations that involve customer contact, investigation, and settlement of claims for and against the organization. Approves all claim settlements both for ..
Description Humana Healthy Horizons in Louisiana is seeking a Manager, Utilization Management (Behavioral Health) who will utilize clinical skills to support the coordination, documentation, and communication of behavioral health services and/or ..
Description Humana Healthy Horizons in Louisiana is seeking RN Managers of Care Management who will lead our physical health/behavioral health care management operations and staff to ensure timely and culturally-competent delivery ..
... of concern and recommendations for improvement, including corrective action requests in ... schedules. Train providers on auditing process and develop educational material related ... in driving provider level quality..
... with benchmarks, identify opportunities for process improvement, and develop recommendations to leadership. ... Bachelor's degree in health services, healthcare administration, or related field. Experience ... managing staff who review..
Description Humana Healthy Horizons in Louisiana is seeking a RN, Clinical Educator (Nursing Educator 2) who will plan, direct, coordinate, evaluate, develop, and/or deliver trainings and education programs for professional nursing, ..
Description The Medicaid Housing Specialist (Care Management Support Professional 1)contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or ..
... is seeking a Manager, Quality Improvement who will implement and monitor ... will implement and monitor quality improvement program components, including annual program ... annual evaluation. The Manager, Quality..