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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 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 ..
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 ... Care Management Support Assistant 2/Medicaid (Bilingual English/Spanish or Creole) Remote FL ... Market Office quarterly (see additional Information below) Required Qualifications 1..
Job Information Humana Supervisor, Grievances & Appeals ... including Word, Excel, and Outlook Bilingual English/Spanish - must be able ... Microsoft PowerPoint and Access Additional Information Any Humana associate who..
Job Information Humana Telephonic Behavioral Health Care ... department prefers candidates that are bilingual in both English and Spanish. ... Spanish. This does not exclude non-bilingual candidates If you are..
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 ..
