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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 ..
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Description The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Compliance Nurse ..
... and communication of medical services and/or benefit administration determinations. The Utilization ... any given day, week, weekend, or holiday. The Utilization Management Nurse ... and most appropriate treatment, care..
... 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..
... analyzes data daily, weekly, monthly or as needed to assess outcome ... and could lead multiple managers or highly specialized professional associates. The ... Qualifications *Bachelor's Degree in health..
... 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 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 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, ..
... 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..
Immediate openings for full-time and part-time Resident Aides and CNAs at Brookdale Rio Rancho Assisted Living. We're pleased to rank as a top place to work, offering our care team a ..
... 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..
... 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,..
... 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..
... 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..
... as assigned by Supervisor, Manager and/or Director. 5% Utilizes established reporting ... description in no way states or implies that the key accountabilities ... required to follow other instructions..
... and communication of medical services and/or benefit administration determinations. The Utilization ... - Registered Nurse completes telephonic and/or faxed reviews with the Utilization ... 7am - 6:30 p.m. CST..
... and policies, and approves services or forwards requests as needed. The ... license from list: Registered Nurse (RN) with Compact License 3 years ... years of practice experience 1..
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 ..
... 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..
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 ..
