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Description The RN, Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The RN ..
Description The Compliance (UM) Professional 2 conducts and summarizes compliance audits. The Compliance (UM) Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses ..
Description The Subrogation Professional 2 iIdentifies, investigates, and collects recoveries from third parties who are legally responsible for paying all or part of medical expenditures for an organization that provides health ..
Description The Grievances & Appeals Professional 2 manages client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. The Grievances & Appeals ..
Job Information Humana OB Care Management Support Assistant 2/Medicaid (Bilingual English/Spanish or Creole) Remote FL in Saint Augustine Florida Description The Care Management Support Assistant 2 contributes to administration of care ..
Job Information Humana Telephonic Behavioral Health Care ... protect member PHI / HIPAA information. Additional information The department prefers candidates that ... working in the field. Additional information As part..
Description The Care Coach 1 assesses and evaluates member's needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the ..
Job Information Humana Supervisor, Grievances & Appeals ... Microsoft PowerPoint and Access Additional Information Any Humana associate who speaks ... with instructions to add the information into the application at..
Description The Referral Coordinator 1 schedules and pre-registers patients for exams and procedures with specialists and providers outside of the primary care physician's office. The Referral Coordinator 1 performs basic administrative/clerical/operational/customer ..
