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Description Responsibilities The Associate Director for ACD Audit , at the director of the Director of Payment Integrity, will create and implement process improvement plans focused on the beneficiary and provider ..
Description The Supervisor, Consultative Pharmacy Technicians certified Pharmacy Technician who acts as an intake for all calls from patients, pharmacies and providers. The Supervisor, Consultative Pharmacy Technicians works within thorough, prescribed ..
Description Responsibilities The Compliance Professional 2 has responsibilities for performing clinical audits on medical record documentation for quality and clinical compliance with contract requirements as outlined in the Autism Care Demonstration ..
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 Supervisor, Compliance Nursing reviews utilization management ... fraud, waste, and abuse. The Supervisor, Compliance Nursing works within thorough, ... procedures; uses independent judgment requiring analysis of variable factors..
Description Responsibilities The Business Support Coordinator 1 performs medical record content analysis to ensure compliance with requirements of the TRICARE contract. Prepare, scan, and stage for final distribution all medical records ..
Description The Supervisor, Pre-Authorization Nursing reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The Supervisor, Pre-Authorization ..
Description The Supervisor, Care Management Support contributes to ... and wellbeing of members. The Supervisor, Care Management Support works within ... procedures; uses independent judgment requiring analysis of variable factors..
... Information Humana Pre- Authorization Nursing Supervisor-- REMOTE/WORK AT HOME (Anywhere in ... in Brentwood Tennessee Description The Supervisor, Pre-Authorization Nursing will be managing ... to the appropriate stakeholder. The..
Description The Compliance (UM) Coordinator 3 conducts and summarizes compliance audits. The Compliance (UM) Coordinator 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical ..
Description The Supervisor, UM Administration contributes to administration ... administration of utilization management. The Supervisor, UM Administration works within thorough, ... procedures; uses independent judgment requiring analysis of variable factors..
Job Information Humana Care Management Supervisor (Prescription Assistance Program)- CenterWell-Remote in ... in Brentwood Tennessee Description The Supervisor, Care Management leads teams of ... and wellbeing of members. The Supervisor,..
Description Responsibilities The Consumer Service Operations Professional 2 evaluates claims oversight performance metrics by interfacing with the sub-contractor to gather and track associated reporting. The Consumer Service Operations Professional 2 evaluates ..
... a long-term care facility The Supervisor, Care Management Support will lead ... and wellbeing of members. The Supervisor, Care Management Support works within ... procedures; uses independent judgment requiring..
... requested by his or her supervisor, consistent with the purpose of ... Public Health Administration, Public Policy, Healthcare Economics, Business or related field ... expertise in population health, data..
... to complex issues where the analysis of situations or data requires ... to complex issues where the analysis of situations or data requires ... 25% Perform Project Planning and..
