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... coordination, documentation, and communication of medical services and/or benefit administration determinations. ... Behavioral Health Professional 2 completes medical record reviews from medical records sent from Behavioral Health ... appropriate..
Description The Senior Pharmacy Sales Executive leverages targeted geographic analysis, engages with Physician offices to influence physicians to route patients' prescriptions to Humana Pharmacy for fulfillment. The Senior Pharmacy Sales Executive ..
Description The Medical Director relies on medical background and reviews health claims. ... and reviews health claims. The Medical Director work assignments involve moderately complex ... variable factors. Responsibilities Job..
Description The Vendor Quality Medical Director will manage clinical vendor quality ... Team. Responsibilities A full time Medical Director to manage clinical vendor quality ... to review quality audit findings,..
Nursing House Supervisor - PRN Department: House Supervisors Location: Rio Rancho, NM START YOUR APPLICATION Job Summary and Scope Responsible for the overall operations, and implementation and evaluation of activities for ..
Description The Medical Director relies on medical background and reviews health claims. ... and reviews health claims. The Medical Director work assignments involve moderately complex ... of variable factors. Responsibilities..
Description Responsibilities The Utilization Management Nurse 2 will be responsible for performing clinical audits on medical record documentation for quality and clinical compliance with contract requirements as outlined in the Autism ..
Description The Clinical Pharmacy Lead monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders. Utilizes broad understanding of managed care and PBM knowledge to develop, and/or ..
Description The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management ..
... brand for a primary care medical group practice with centers open ... of care. Follows level of medical care and quality for patients ... hospital and SNF coordination, durable..
... University of New Mexico-Sandoval Regional Medical Center (UNM-SRMC). Oversee pharmacy technicians ... duties as assigned Confer with medical personnel to correct problems with ... when assigned Educates hospital and..
Job ID 21000FKWAvailable Openings 1 PURPOSE AND SCOPE: Functions as part of the hemodialysis health care team in providing safe and effective dialysis therapy for patients under the direct supervision of ..
Description The UM Administration Coordinator contributes to administration of utilization management. The UM Administration Coordinator performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. ..
... and retro reviews evaluating the medical necessity, appropriateness and efficient use ... refers to Case manager or Director of Case Management as appropriate. ... issues to the Physician Advisor,..
Description The Compliance Nurse 2 reviews medical management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Compliance Nurse ..
Description The Medical Director relies on medical background and reviews health claims. ... and reviews health claims. The Medical Director work assignments involve moderately complex ... factors. Responsibilities Job Profile..
... Evaluate the element of the medical record for diagnosis code selection ... Query providers to obtain additional medical record documentation or to clarify ... matrix environment of coding educators,..
Description The Medical Director actively uses their medical background, experience, and judgement to ... conferences, and other reference sources. Medical Directors will learn Commercial requirements ... daily work. Responsibilities Title:..
Nursing House Supervisor - PT 0.5 Department: House Supervisors Location: Rio Rancho, NM START YOUR APPLICATION Job Summary and Scope Responsible for the overall operations, and implementation and evaluation of activities ..
