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... Information Humana Medicaid Associate Director, Compliance Nursing in Portland Maine Description ... Maine Description The Associate Director, Compliance Nursing reviews utilization management activities ... and abuse. The Associate Director,..
Description The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within ..
... physicians, physician groups, and integrated healthcare delivery systems throughout the country. ... delivery systems throughout the country. Healthcare isn't just about health anymore. ... of our members, and the..
Description The Senior Health Information Management Professional ensures data integrity for claims errors. The Senior Health Information Management Professional work assignments involve moderately complex to complex issues where the analysis of ..
... within a context of regulatory compliance, and work is assisted by ... whether services provided by other healthcare professionals are in agreement with ... departments, Humana colleagues and the..
... performing complex tasks related to compliance with accreditation standards across multiple ... performing complex tasks related to compliance with accreditation standards across multiple ... resolving deficiencies that impact plan..
Description Responsibilities This position will maintain the Humana Military ACD website Autism Center of Excellence (CoE); ensuring educational information is current and relevant to training needs in addition to analyzing and ..
... support of remote dispensing and compliance in Hospice IPU (Inpatient Unit) ... support of remote dispensing and compliance in Hospice IPU settings. Essential ... Daily generation and review of..
Description The Senior Compliance Professional ensures compliance with governmental requirements. The Senior ... with governmental requirements. The Senior Compliance Professional work assignments involve moderately ... variable factors. Responsibilities Seeking Senior..
Description The Senior Clinical Business Professional is a clinical partner to the Commercial Product Strategy team. The Senior Clinical Business Professional work assignments involve moderately complex to complex issues where the ..
Description Responsibilities The Autism Care Demonstration (ACD) Senior Learning Design Professional analyzes content, organizes content, designs solutions, and writes storyboards, scripts, performance support, newsletters and notification letters. Analyzes learning needs and ..
Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires ..
Description Responsibilities The Compliance Professional 2 has responsibilities for ... documentation for quality and clinical compliance with contract requirements as outlined ... ensure all providers are in compliance based on..
Description The Principal Quality Leader will lead testing and quality collaboration between Business and IT, guiding test strategies and tools and assure adherence to quality standards. Serves as point of contact ..
Description The Actuary, Pricing MA-PD is responsible for setting pricing assumptions, submitting bids, filing and gaining approval of premium rates and rate certifications with regulatory agencies. Supports implementation of rates, new ..
Description The Pharmacy Claims Lead operationalizes and monitors Coordination of Benefits (COB) and subrogation claim processing logic and processes. Exercises independent judgment and decision making on managing staff, complex issues regarding ..
Description Responsibilities The Care Manager, Behavioral Health 2 (BCBA) is responsible for the administration and monitoring of the Autism Care Demonstration (ACD) including coordination of services for ABA Therapy, benefits provided ..
... Information Humana Actuary, Risk and Compliance in Portland Maine Description This ... within the Senior Products Actuarial Compliance team focused on special Medicare ... special programs, this role supports..
Description The Behavioral Health Parity Compliance Lead will play an integral ... of our Mental Health Parity Compliance Program. Responsibilities This role is ... Healthy Horizons Mental Health Parity Compliance..
Description The Director, Provider Reimbursement is responsible for the leadership, strategy development and execution of Humana Military's provider reimbursement methodologies. This leader is responsible for timely and accurate implementation of Government ..
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 ..
