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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..
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... Information Humana Medicaid Associate Director, Compliance Nursing in Troy Michigan Description ... Michigan Description The Associate Director, Compliance Nursing reviews utilization management activities ... and abuse. The Associate Director,..
... 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..
... 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..
... 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 ... the development and implementation of..
... 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 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 ..
... 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..
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 ..
... 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,..
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 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 ..
... 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..
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 ..
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 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 ..
... 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,..
... 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..
Description Responsibilities The Compliance Professional 2 has responsibilities for ... on medical record documentation for quality and clinical compliance with contract requirements as outlined ... CPT Codes. KEY ACCOUNTABILITIES 95%..
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..
