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... 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 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 ..
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 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..
... 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..
... 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..
... met. JOB REQUIREMENTS QUALIFICATIONS CNA or HHA license preferred, or 6 months of full-time work ... 6 months of full-time work or 12 months of part-time work ... part-time..
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, ..
We are seeking a CNA Caregiver to join our team! You will assist in the daily care of elderly or disabled individuals. Responsibilities: Assist clients with daily living activities Communicate ongoing ..
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 ..
... 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 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 ..
... 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 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..
... 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 ..
... 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..
... 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,..
