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Our Health and Benefits business helps large and mid-size clients control health and welfare plan costs, improve health outcomes and promote employee engagement through broad-based, state-of-the-art interventions. We provide solutions encompassing ..
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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 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 ..
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 ..
... Medical Coding Auditors Assists the Audit Manager with data analysis, team management, ... guidelines Prepares written summaries of audit findings Presents verbal audit feedback and provides education upon .....
... (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 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, ..
Job Information Humana Medicaid Associate Director, Compliance Nursing in San Antonio Texas Description The Associate Director, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and ..
... 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..
... 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..
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 Responsibilities Participates in all activities associated with delegated credentialing and recredentialing of providers in the TRICARE East Region, and Humana Government Business subsidiaries' networks. Monitors delegated organizations in processing provider ..
