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Description Responsibilities The ACD Referral Authorization Coordinator Lead role will assist the Supervisor in oversight & monitoring of processing and timeliness standards for referrals and authorizations under the Autism Care Demonstration ..
Description Responsibilities The Associate Director for ACD Audit , at the director of the Director of Payment Integrity, will create and implement process improvement plans focused on the beneficiary and provider ..
Job ID 21000GG1Available Openings 1 PURPOSE AND SCOPE: Manages the provision of quality patient care in an independent home therapy program while maintaining cost-effective clinical operations in accordance with all legal, ..
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 ..
Description The Senior Compliance Nurse reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Senior Compliance ..
Description In order to make lasting, positive impact and change in the healthy equity of the communities we serve, leveraging the support of key stakeholders will be critical. As healthy equity ..
Description Job Description Summary The RVP Health Services relies on medical background to create and oversee clinical strategy for the state of Florida. The RVP Health Services requires an in-depth understanding ..
Description Responsibilities This role within the Autism Care Demonstration (ACD) Team, will work closely with Care Management leaders and Subject Matter Experts in the areas of Case Management, Utilization Management and ..
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 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 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 ..
Description Humana Military, a wholly-owned subsidiary of Humana Inc. headquartered in Louisville, KY, partners with the Department of Defense to administer the TRICARE health program for military members, retirees and their ..
Description This role has responsibility for the oversight and monitoring of the Autism Care Demonstration (ACD) team performance to ensure compliance with contract and complex ACD policy requirements as defined by ..
Job Information Humana Administration Sales Coordinator - CarePlus Miami, FL(Bilingual) in Miami Florida Description Are you passionate about contributing to the well-being of the Medicare population? Would you like to provide ..
Job Information Humana Manager of Sales Administration - Palm Beach, FL in Delray Beach Florida Description Are you passionate about contributing to the well-being of the Medicare population? Are you looking ..
Job Information Humana Social Worker-MSW and licensure required- Telephonic Behavioral Health-SNP- WAH Nationwide in Tampa Florida Description The Care Manager, Telephonic Behavioral Health 2 , in a telephonic environment, assesses and ..
Description The Fraud Investigation Technician 2 conducts investigations of allegations of fraudulent and abusive practices. The Fraud Investigation Technician 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. ..
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 The Clinical Programs Pharmacy Technician Representative 2 integrates programs developed to improve overall health outcomes with a focus on prescription drugs. The Clinical Programs Pharmacy Technician Representative 2 performs varied ..
Description Humana is a $77 billion (Fortune 41) market leader in integrated healthcare with a clearly defined purpose to help people achieve lifelong well-being. As a company focused on the health ..
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 ..
Job Information Humana Care Manager, Telephonic Behavioral Health 2 - Remote, US in Tampa Florida Description Humana Military, a wholly-owned subsidiary of Humana Inc. headquartered in Louisville, KY, partners with the ..
