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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..
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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 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 Senior Pre-Authorization Nurse reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. Makes decisions on ..
... with all legal, compliance, and regulatory requirements and programs. Takes the ... meet schedules and goals.Program or project responsibility generally within the Home ... effort among members of a..
... provider experience, as well as project manage the market rollout end-to-end. ... Medicaid markets Create and manage project plans to ensure effective and ... and timelines for provider services..
Description The Manager, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Manager, Compliance ..
Job Information Humana Senior Project Manager -- Remote in Indianapolis Indiana ... Indianapolis Indiana Description The Senior Project Manager manages all aspects of a ... manages all aspects of a..
... Vice President for Healthcare, the Project Director will be responsible for ... be primarily responsible for coordinating project deliverables, reporting, financial management, and ... 31, 2025. Major Responsibilities: Provide..
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 ..
Job Information Humana UM Medical Director - Conviva in Indianapolis Indiana Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..
... Compliance Program, including following all regulatory and FMS policy requirements. Ensure ... with all legal, compliance, and regulatory requirements and programs. Adheres to ... standards through meeting all ESRD..
... of the Executive Director of Project Implementation and Management, the Director ... Assist the Executive Director for Project Implementation & Management, School of ... Healthcare, the Executive Director for..
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 ..
