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Description The RN, Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The RN, ..
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Description The Account Management Professional 2 is responsible for ... with client accounts. The Account Management Professional 2 work assignments are ... of action. Responsibilities The Account Management Professional 2..
Description The Behavioral Health Lead utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Behavioral Health Lead works on ..
Description The Product Manager 2 Conceives of, develops, delivers, and manages products for customer use. The Product Manager 2 work assignments are varied and frequently require interpretation and independent determination of ..
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 Care Management Support Assistant 2 contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal ..
Barbas, Nunez, Sanders, Butler & Hovsepian seeks a bilingual (Spanish) Personal Injury Litigation Paralegal for our Tampa office. Please provide comprehensive information/resume outlining experience, as well as salary requirements and any ..
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 ..
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 Activity Coordination Assistant 1 ensures the day-to-day operations of the CarePlus Community Center meets participant needs. The Activity Coordination Assistant 1 performs basic administrative/clerical/operational/customer support/computational tasks. Typically works on ..
Description The Supervisor, Grievances & Appeals manages client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. The Supervisor, Grievances & Appeals ..
Description At Conviva Care Solutions, we want to inspire people to live life their best healthy life. Conviva Care Solutions is a management services organization representing nearly 300 physician practices, 800 ..
Description The Utilization Management Behavioral Health Professional 2 utilizes ... benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work ... of action. Responsibilities The Utilization Management Behavioral Health..
Description The Senior Community Centers Professional assumes broad responsibility for a defined geographic region containing member centered community centers for CarePlus. The Senior Community Centers Professional work assignments involve moderately complex ..
Job Information Humana Care Coach 1 - Bilingual (English/Spanish) - Tampa, FL in Tampa Florida Description The Care Coach 1 assesses and evaluates member's needs and requirements to achieve and/or maintain ..
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 Associate Director, Grievances & Appeals manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if an a grievance, appeal or further request ..
Description The Care Management Support Assistant 2 (CMSA2) contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain ..
Description The Bilingual Production Professional 2 produces of a wide range of print projects for external and internal audiences. The Bilingual Production Professional 2 work assignments are varied and frequently require ..
Description The Utilization Management Nurse 2 utilizes clinical nursing ... benefit administration determinations. The Utilization Management Nurse 2 work assignments are ... training and by leader. Utilization Management Nurse 2..
