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Humana
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Raleigh, North Carolina
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national clinical guidelines, CMS policies and determinations, clinical reference materials, internal ... Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios
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Humana
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Raleigh, North Carolina
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position with responsibility for utilization management and clinical decision-making as outlined in the ... associate will conduct clinical necessity reviews for requested ABA services when approving all treatment
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Humana
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Raleigh, North Carolina
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organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical ... national clinical guidelines, CMS policies and determinations, clinical reference materials, internal
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Humana
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Raleigh, North Carolina
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organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical ... assisted by diverse resources which may include national clinical guidelines, CMS policies and
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Humana
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Raleigh, North Carolina
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/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management ... regulatory compliance, and work is assisted by diverse resources, which may include national clinical
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Humana
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Raleigh, North Carolina
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, Practice Transformation, Data Analytics, Post-Acute Care and Clinical Quality, and the opportunity to ... tailor their experience through various projects in quality oversight, data reporting, performance
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Humana
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Raleigh, North Carolina
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provider contract payments in our payer systems, and by ensuring correct claims payment for appropriate CPT ... payments in our payer systems, and by ensuring correct claims payment for appropriate CPT/ HCPCS code
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Humana
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Jacksonville, North Carolina
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Nursing, Healthcare Administration or other related field
MCG Criteria knowledge and prior clinical ... the care and service they need, when they need it. These efforts are leading to a better quality of
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