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Description The Supervisor, Inbound Contacts represents the company by addressing incoming telephone, digital, or written inquiries. The Supervisor, Inbound Contacts works within thorough, prescribed guidelines and procedures; uses independent judgment requiring ..
Description The Inbound Contacts Representative 4 represents the company by addressing incoming telephone, digital, or written inquiries. The Inbound Contacts Representative 4 assumes ownership and leads advanced and highly specialized administrative/operational/customer ..
Description Responsibilities The Associate Director for ACD Audit , ... as optimizing operational processes. The Associate Director will lead design and ... to the ACD leaders. The Associate Director will..
Description The Associate Actuary, SPA RX will be mainly responsible for supporting the pricing work related to our standalone Prescription Drug Plans (PDPs). This includes both bid development and reforecasts throughout ..
Description The Associate Actuary, Analytics/Forecasting analyzes and forecasts financial, economic, and other data to provide accurate and timely information for claims reserve valuation, financial forecasting, and strategic and operational decisions within ..
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 ..
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 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 The Senior Clinical Strategy and Practice Professional builds strategies for development, engagement, best clinical practices and processes for clinical community within the enterprise The Senior Clinical Strategy and Practice Professional ..
Job Information Humana Actuary, Risk and Compliance in Albuquerque New Mexico Description This Actuary role is a newly created role within the Senior Products Actuarial Compliance team focused on special Medicare ..
... 60 market leader in integrated healthcare with a clearly defined purpose ... experience and vitality of the associate community. Through offerings anchored in ... us redefine the future of..
... that our members receive quality healthcare at an affordable price. You ... (RN) license 3 years of healthcare experience within a fraud investigations ... well as solid knowledge of..
... degree Advanced degree in a healthcare-related field Knowledge of NCQA accreditation ... & Health Promotion Accreditation, Multicultural Healthcare Distinction, and/or LTSS Distinction Auditing ... job as we are a..
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 Principal Quality Leader will lead testing and quality collaboration between Business and IT, guiding test strategies and tools and assure adherence to quality standards. Serves as point of contact ..
... roadmaps. Working closely with the Associate Vice President of Pharmacy Product ... insights Bachelor's degree in Business, Healthcare Administration or other related fields ... 50 market leader in integrated..
Description As the Associate Director, IT Project Management, you will use your background and experience in program management to lead and manage a team of PMO professionals that support the delivery ..
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 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 ..
... large accounts and/or provider relations Associate management oversight of 3-5 direct ... and network administration in a healthcare company or healthcare system Medicaid behavioral health contracting ... in the..
Description The Actuary, Analytics/Forecasting will develop the financial forecast for the dental and vision benefits included within Humana's growing Medicare Advantage business, as well as pricing and oversight of other stand ..
Description The Staff Utilization Management Pharmacist is a clinical pharmacist who completes medical necessity and comprehensive medication reviews for prescriptions requiring pre-authorization. The Staff Utilization Management Pharmacist work assignments involve moderately ..
Job Information Humana Medicaid Associate Director, Compliance Nursing in Albuquerque ... Albuquerque New Mexico Description The Associate Director, Compliance Nursing reviews utilization ... fraud, waste, and abuse. The Associate Director,..
