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Description Responsibilities The Senior Quality Assurance (Home Health) Clinical Professional consults and collaborates with clinicians/nurses to ensure high accountability of compliance and quality and claims are being reviewed correctly. This position ..
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... plans, directs, coordinates, evaluates, develops, and/or delivers training and education programs ... where the analysis of situations or data requires an in-depth evaluation ... to, Care Management, Utilization Management,..
... and communication of medical services and/or benefit administration determinations. The Manager, ... and most appropriate treatment, care or services for members. Coordinates and ... and communicates with providers, members,..
Description The Utilization Management Nurse 2 utilizes clinical nursing skills ... and communication of medical services and/or benefit administration determinations. The Utilization ... administration determinations. The Utilization Management Nurse 2..
... the team with a Senior Nurse Auditor roles! This is a ... you answered YES to one or more of the above you ... should strongly consider the Senior..
... needs and requirements to achieve and/or maintain optimal wellness state by ... allow each member to achieve and/or maintain their optimal health. Apply ... on identified needs and recommend..
... and communication of medical services and/or benefit administration determinations. The Utilization ... Behavioral Health Professional 2 - Registered Nurse completes telephonic and/or faxed reviews with the Utilization ... Compact..
Description The Nurse Auditor 2 performs clinical audit/validation ... to support optimal reimbursement. The Nurse Auditor 2 work assignments are ... overpayments when they happen. The Nurse Auditor 2 validates..
... in care, eligibility for assistance and/or need for care management program ... need for care management program or other referral services in collaboration ... Social Determinants of Health needs..
... and policies, and approves services or forwards requests as needed. The ... Behavioral Health Professional 2 - Registered Nurse you will contribute to the ... and unrestricted license from..
Description The Care Manager, Telephonic Nurse 2 , in a telephonic ... needs and requirements to achieve and/or maintain optimal wellness state by ... members. The Care Manager, Telephonic Nurse..
... is actively recruiting a Neonatal Nurse Practitioner, Pediatric Nurse Practitioner or Family Nurse Practitioner to join our established ... essential function of this job.,industry:Healthcare,title:Pediatric Nurse Practitioner,datePosted:2021-07-16T20:04:02.210 0000,@context:http://schema.org,occupationalCategory:Advanced Practitioner,responsibilities:Providing on-site..
Description The WEEKEND Pre-Authorization Behavioral Health Professional 2 reviews prior authorization requests for appropriate care and setting, follows guidelines and policies, and approves services or forwards requests as needed. The Pre-Authorization ..
... and communication of medical services and/or benefit administration determinations. The Director, ... capabilities interrelate across the function or segment. Responsibilities As Humana's Medicaid ... and most appropriate treatment, care..
