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... overseeing the vendor's claims processing operations and systems. The Director, Claims Oversight plays a vital ... comprised of four units: claims operations, claims systems change management, claims ... Medical..
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... across all areas impacting DCE operations, performance, experience, and outcomes including ... will report directly to the Director of Value-Based Strategies - CMS ... Bachelor's Degree 5 years in..
Description As the Director, Sales Product -Employer Group you will be responsible for defining and executing upon the sales product strategy & enablement plans across specific local markets and lines of ..
Description The Director of Health Services for National ... Services for National Medicaid Clinical Operations utilizes clinical skills to support ... and/or benefit administration determinations. The Director, Health Services requires..
Description The Medical Director actively uses their medical background, ... work. Responsibilities Title: Commercial Medical Director Location: Work At Home - ... weeks. Job Summary The Medical Director's work includes..
Description Humana is seeking an experienced management professional to lead an interactive team with broad exposure and scope within Humana. This position will work and collaborate with leaders across the Humana ..
Description The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management ..
Description The Director, QOCA Strategy - serves as the strategic leader in resource utilization; budget and MER oversight; vendor oversight; and for clinician and non-clinician flex associates and off-shore vendor associates ..
Description The Associate Director, Utilization Management Nursing utilizes clinical ... benefit administration determinations. The Associate Director, Utilization Management Nursing requires a ... grow, the National Medicaid Clinical Operations team is..
... closely with the market QI director on a frequent basis. Support ... expertise within the realm of Healthcare Quality operations and improvement methodology, HEDIS/CAHPS and ... a subject matter..
Description Responsibilities Humana's Corporate Strategy team is a small, high-performing organization that works closely with Humana's senior leadership to chart the course for the company's future. Within Strategy Operations, you will ..
Description o Our search is focused on identifying an individual contributor who will take ownership of Medicare risk adjustment programs that fit best with our providers by implementing operational and clinical ..
... grow, the National Medicaid Clinical Operations team is expanding our shared ... delivery process. The National Medicaid Director of Clinical Strategy and Practice ... community within the enterprise. The..
Job Description $2000 Sign-On Bonus for qualified new hires! The Licensed Vocational Nurse (LVN)/ Licensed Practical Nurse (LPN) in expanded scope clinics is an integral part of the clinic team inside ..
Description The UM Administration Coordinator contributes to administration of utilization management. The UM Administration Coordinator performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. ..
Description The Director, Provider Reimbursement is responsible for ... the organization to include Network Operations, Provider Administration, Claims, and IT. ... team of associates. Responsibilities The Director, Provider Reimbursement develops..
Description The Vendor Quality Medical Director will manage clinical vendor quality outcomes for Humana Clinical Operations Team. Responsibilities A full time Medical Director to manage clinical vendor quality outcomes for Humana ..
FT/40 hrs. This position is responsible for supervising case managers and interns, training new case managers, and providing support and assistance to Case Managers. The Supervising Case Manager will also be ..
... for diagnosis code selection Educate healthcare provider, coder and/or office staff ... long-term, self-sustaining solution for the healthcare provider's practice Assist healthcare providers to document accurately and ... environment..
Job Information Humana Medicaid Associate Director, Compliance Nursing in Phoenix Arizona ... Phoenix Arizona Description The Associate Director, Compliance Nursing reviews utilization management ... waste, and abuse. The Associate Director,..
Description The Supervisor, Care Management Support 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 wellness ..
Description The Director of Product Management for Clinical ... business acumen. Responsibilities As the Director of Product Management for Clinical ... and services. Partners closely with operations, vendors, customer success..
