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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..
Description The Provider Relations Manager - Behavioral Health (BH) oversees, leads, and supports a team of associates that grow positive, long-term relationships with contracted BH providers in order to facilitate a ..
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Job Information Humana UM Medical Director - Conviva in Metairie Louisiana Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..
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 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 ..
... 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 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 ..
... provider services functions to meet regulatory requirements and support provider services ... aligned with State contract and regulatory requirements. Ensures compliance with contractual ... on operational trends and gaps..
Job Information Humana Senior Project Manager -- Remote in Metairie Louisiana ... Metairie Louisiana Description The Senior Project Manager manages all aspects of a ... manages all aspects of a..
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 ..
