Job Summary: The Program Integrity Medical Coding Reviewer III supports most complex medical record audit programs, dispute management, escalation management and generates concise in-depth reporting and analysis to track performance related to the Pre-Pay and Post-Paid
Job Summary: The Clinical Psychologist provides Behavioral Health coverage determination for utilization management to ensure members receive appropriate and medically necessary care in the most cost-effective setting. Essential Functions: Assume responsibility for the overall safety of
Job Summary: The Actuarial Analyst I is responsible for providing timely, accurate, and actionable data and analysis supporting the department, area, and corporate key initiatives. Essential Functions: Develops actionable recommendations to management relative to all analysis
Job Summary: The Enterprise Medical Director is responsible for the development, implementation and revision of corporate level clinical care standards and practice guidelines, ensuring compliance with nationally accepted quality standards. Essential Functions: Development, implementation and revision