THE LARGEST COLLECTION OF HEALTHCARE JOBS ON EARTH
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... testing Identify gaps in the quality assurance and testing processes, generate ... bugs are resolved Help ensure compliance with client, agency, and company ... detail Salesforce, Appian, and/or previous..
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 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..
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 ..
... philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory ... procedures, and training and in compliance with regulations set forth by ... the FMCNA commitment to the..
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 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..
... on medical record documentation for quality and clinical compliance with contract requirements as outlined ... for this position . 75% Quality Monitoring Audits. Review and assess ... ensure all..
... 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..
... is committed to providing personalized, high-quality primary care combined with an ... based care provider focused on quality of care for the patients ... nurses, MAs, behavioral health specialists,..
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..
... 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..
... 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..
... business reviews in accordance with compliance requirements advise Commercial Product of ... recommend opportunities to optimize vendor quality Facilitate the measurement of success ... and/or service level oversight including..
... is committed to providing personalized, high-quality primary care combined with an ... based care provider focused on quality of care for the patients ... Nurse, MA, Behavioral health specialist,..
... 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..
... Information Humana Medicaid Associate Director, Compliance Nursing in Atlanta Georgia Description ... Georgia Description The Associate Director, Compliance Nursing reviews utilization management activities ... and abuse. The Associate Director,..
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 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..
