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Description The Quality Assurance, Clinical Professional 2 consults ... to ensure high accountability of compliance and quality. The Quality Assurance, Clinical Professional 2 work ... courses of action. Responsibilities The..
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... works within a framework of compliance expectations leading to significant variabilities ... advocate environment focused on high quality outcomes versus activities. Our department ... of their care. We value..
Description The Senior Quality Assurance, Clinical Professional requires being ... to ensure high accountability of compliance and quality and will work assignments involving ... Categories) coding documentation guidelines and compliance..
... 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 Care Manager, Telephonic Behavioral Health 2, in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and ..
... philosophy. Adheres to the FMCNA Compliance Program, including followingall regulatory and ... and other members of the healthcare team to interpret, adjust, and ... delivery of patient care in..
... within a context of regulatory compliance, and work is assisted by ... whether services provided by other healthcare professionals are in agreement with ... meeting departmental expectations, and meets..
Description The Principal Quality Leader will lead testing and ... Leader will lead testing and quality collaboration between Business and IT, ... tools and assure adherence to quality standards. Serves..
... 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..
Description The Director, Strategy Advancement provides data-based strategic direction identifying and delivering new avenues of growth is a critical company priority, championed by the SVP of Retail Strategy & Product. We're ..
Description Responsibilities The Senior Quality Assurance (Home Health) Clinical Professional ... to ensure high accountability of compliance and quality and claims are being reviewed ... implements programs to establish high..
... Develop and monitor performance and quality of initiatives, providing insight and ... needs, data needs, provider audit compliance etc. 20 % Develop deep ... lead development of meaningful QIPs..
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 ..
... performing complex tasks related to compliance with accreditation standards across multiple ... performing complex tasks related to compliance with accreditation standards across multiple ... the development and implementation of..
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 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 The Care Manager, Telephonic Behavioral Health 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward ..
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 ..
... Member Plan (EFMP), auditing for quality and clinical compliance, and case management. Serve as ... ABA treatment plans for policy compliance. Assist with analysis of necessary ... Review outcome..
... Information Humana Medicaid Associate Director, Compliance Nursing in Dover Delaware Description ... Delaware Description The Associate Director, Compliance Nursing reviews utilization management activities ... and abuse. The Associate Director,..
