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Description The Behavioral Health Parity Compliance Lead will play an integral role in the oversight and management of our Mental Health Parity Compliance Program. Responsibilities This role is responsible for monitoring ..
Description The Care Manager, Telephonic Behavioral Health 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward ..
Description The Care Manager, Telephonic Nurse 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and ..
Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires ..
Description Responsibilities The Utilization Management Nurse 2 will be responsible for performing clinical audits on medical record documentation for quality and clinical compliance with contract requirements as outlined in the Autism ..
Description The Wellness Coach 2 supports health promotion and disease prevention and care management services. The Wellness Coach 2 work assignments are varied and frequently require interpretation and independent determination of ..
Description The Referrals Coordinator 2 process referrals from Military Treatment Facilities (MTFs) and civilian providers. The Referrals Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically ..
Description The Senior Compliance Professional ensures compliance with governmental requirements. The Senior Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an ..
Description The Risk Adjustment Representative 3 works with regional provider offices to ensure timely submission of requested medical records that are submitted to the Centers for Medicare and Medicaid Services (CMS) ..
... 41) market leader in integrated healthcare with a clearly defined purpose ... we are seeking an experienced healthcare leader to join our team ... President, Strategy Advancement for our..
Description Responsibilities The Care Manager, Behavioral Health 2 (BCBA) is responsible for the administration and monitoring of the Autism Care Demonstration (ACD) including coordination of services for ABA Therapy, benefits provided ..
Description The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All ..
Description Responsibilities This position will maintain the Humana Military ACD website Autism Center of Excellence (CoE); ensuring educational information is current and relevant to training needs in addition to analyzing and ..
Description Responsibilities The Autism Care Demonstration (ACD) Senior Learning Design Professional analyzes content, organizes content, designs solutions, and writes storyboards, scripts, performance support, newsletters and notification letters. Analyzes learning needs and ..
Description The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. The ..
Job Information Humana Care Manager, Telephonic Behavioral Health 2 - Remote, US in Newport Rhode Island Description Humana Military, a wholly-owned subsidiary of Humana Inc. headquartered in Louisville, KY, partners with ..
... through TRICARE and other military healthcare programs. High-quality service, cost-effective platforms, ... an essential partner to the Government. Responsibilities The Post Discharge Call ... Care Manager, you represent Humana..
Description Responsibilities The Consumer Service Operations Professional 2 evaluates claims oversight performance metrics by interfacing with the sub-contractor to gather and track associated reporting. The Consumer Service Operations Professional 2 evaluates ..
Job Information Humana Social Worker-MSW and licensure required- Telephonic Behavioral Health-SNP- WAH Nationwide in Newport Rhode Island Description The Care Manager, Telephonic Behavioral Health 2 , in a telephonic environment, assesses ..
Description Responsibilities The Compliance Professional 2 has responsibilities for performing clinical audits on medical record documentation for quality and clinical compliance with contract requirements as outlined in the Autism Care Demonstration ..
Description The Director, Provider Reimbursement is responsible for the leadership, strategy development and execution of Humana Military's provider reimbursement methodologies. This leader is responsible for timely and accurate implementation of Government ..
Description Responsibilities The Care Management Support Assistant 2- ACD Referral Coordinator-will process referrals from Military Treatment Facilities (MTFs) and civilian providers for the ACD program. The ACD Referral Coordinator performs varied ..
