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... 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 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 ..
... you answered YES to one or more of the above you ... Degree Must hold an active RN license Must hold at least ... active coding credential (CPC, CCS,..
... needs and requirements to achieve and/or maintain optimal wellness state by ... monitoring patient care through assessments and/or evaluations. May create member care ... multidisciplinary team. All of our..
Description The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. The ..
Description The Pre-Authorization Nurse 2 reviews Genetic testing prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The ..
... and communication of medical services and/or benefit administration determinations. The Utilization ... and most appropriate treatment, care or services for members. Coordinates and ... and communicates with providers, members,..
Description CenterWell Senior Primary Care, a subsidiary of Humana Inc., is the new brand for a primary care medical group practice with centers open or opening in Florida, Georgia, Kansas, Louisiana, ..
... providers. Required Qualifications Current US RN License with 1 year Coding ... experience in medical record reviews/auditing or extensive experience in Home Health ... Health guidelines including coding, billing..
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 ..
... needs and requirements to achieve and/or maintain optimal wellness state by ... courses of action. Responsibilities The RN Care Manager, Telephonic Nurse 2 ... every 6 months; complete PSI..
... and communication of medical services and/or benefit administration determinations. The Utilization ... Health Professional 2 completes telephonic and/or electronic reviews with the Utilization ... Required Qualifications Degree in Nursing..
... group practice with centers open or opening in Florida, Georgia, Kansas, ... needs and requirements to achieve and/or maintain optimal wellness state by ... established guidelines/procedures. Required Qualifications Active..
... Facility (MTF) UM/CM/DM staff, physicians or providers to ensure there is ... in care, eligibility for assistance and/or need for care management program ... need for care management program..
... 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..
... you answered YES to one or more of the above you ... Required Qualifications Licensed Registered Nurse, RN, in the state of residence ... current coding certifications with AAPC..
