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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..
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..
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..
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..
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..
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 &..
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..
Job Information Humana Telephonic Behavioral Health Care Manager in Saint Augustine Florida Description The Behavioral Health Care Manager, in a telephonic environment, assesses and evaluates members' needs and requirements to..
Job Information Humana Supervisor, Grievances & Appeals in Saint Augustine Florida Description The Supervisor, Grievances & Appeals works within thorough, prescribed guidelines and procedures; uses independent judgment requiring analysis of..
