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Description The Manager, Care Management leads teams of nurses and behavior health professionals responsible for care management. The Manager, Care Management works within specific guidelines and procedures; applies advanced technical knowledge ..
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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..
**Providence is calling a Manager Risk Management South Bay Community ... experience.** **We are seeking a Manager Risk Management South Bay Community** ... Bay Community. The Clinical Risk Manager may..
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 ..
RN, Director Clin Operations','MIL003319','!*!Description - External The Director of Clinical Operations provides general oversight, leadership and 24-hour responsibility for the four Peri-Anesthesia locations and Interventional Radiology/Special Procedures. The Director of Clinical ..
Manager, Clinical Quality Review','21003CI',' At Blue ... of our delegated partners. The Manager, Clinical Quality will report to ... utilization management Ensure compliance with regulatory, legal, contractual requirements, accreditation and..
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 ..
PURPOSE AND SCOPE:The student intern supports FMCNA's mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements. The student ..
Job Information Humana Senior Project Manager -- Remote in Torrance California ... Torrance California Description The Senior Project Manager manages all aspects of a ... manages all aspects of a..
PURPOSE AND SCOPE: Supports FMCNA's mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements. Ensure quality patient care ..
... This is a full-time Clinical Manager role at our Carson, CA ... Compliance Program, including following all regulatory and FMS policy requirements. Ensure ... with all legal, compliance, and..
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 ..
... Compliance Program, including following all regulatory and Organization policy requirements. Provides ... the direction of the Facility Manager, Director of Nursing and/or Charge ... organization quality standards through meeting..
