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Description Humana Military is the Managed Care Support Contractor (MCSC) for the Department of Defense (DoD) charged with administering the TRICARE health plan in the East Region. While the contract is ..
Description The Behavioral Health Clinical Advisor (Care Manager, Telephonic Behavior Health 2) will audit CPT (Current Procedural Terminology) codes to ensure correct billing under TOM (TRICARE Operations Manual) policies in accordance ..
Description The Director of Health Services for National Medicaid Clinical Operations utilizes clinical skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Director, Health ..
... The Associate Director for ACD Audit , at the director of ... Orders, for ACD Program Integrity Audit; driving to operational excellence, repeatable ... system needs, data needs, provider..
Job Information Humana Medicaid Associate Director, Compliance Nursing in Birmingham Alabama Description The Associate Director, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations ..
... (CCM) organization is seeking a Manager, Fraud & Waste to join ... join the Provider Payment Integrity-Clinical Audit team working remote anywhere in ... As the Fraud & Waste..
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 Vendor Quality Medical Director will manage clinical vendor quality outcomes for Humana Clinical Operations Team. Responsibilities A full time Medical Director to manage clinical vendor quality outcomes for Humana ..
... review, provider record updates, and audit preparation as defined by the ... medical records. Print and prepare audit folders. Update the web application ... Qualifications 2 plus years of..
