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... for a Senior Business Systems Analyst to join working remote anywhere ... US! The Senior Business Systems Analyst performs analysis of business, process ... business, process and user needs,..
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Description Humana's recently created Clinical Resource Team is looking to grow the team with a Senior Nurse Auditor roles! This is a unique team that's primary role is to quickly jump ..
... Medicaid Quality Data and Reporting Analyst generates ad hoc reports and ... Medicaid Quality Data and Reporting Analyst will be responsible for the ... including the design, development, testing,..
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 Responsibilities The Business Support Coordinator 1 performs medical record content analysis to ensure compliance with requirements of the TRICARE contract. Prepare, scan, and stage for final distribution all medical records ..
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 ..
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 ..
... with operational areas to prepare documentation and files for presentation to ... degree Advanced degree in a healthcare-related field Knowledge of NCQA accreditation ... & Health Promotion Accreditation, Multicultural..
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 ..
Job ID 21000G0RAvailable Openings 1PURPOSE AND SCOPE: Supports FMCNA’s mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements. ..
Description The Senior Physician Recruiter recruits qualified physicians for medical staff and assists in development of strategic physician recruitment plans. The Senior Physician Recruiter work assignments involve moderately complex to complex ..
Job ID 21000J5VAvailable Openings 1PURPOSE AND SCOPE: Supports FMCNA’s mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements. ..
... and terms. Maintains contracts and documentation within a tracking system. May ... and network administration in a healthcare company or healthcare system Medicaid behavioral health contracting ... in the..
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 Hospital Contracting Executive initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Hospital Contracting Executive works on problems ..
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 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 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 ..
Description Be a part of an interactive team with broad exposure and scope within Humana. Humana is seeking a positive and proactive individual to contribute to a high performing team that ..
Description The Actuary, Pricing MA-PD is responsible for setting pricing assumptions, submitting bids, filing and gaining approval of premium rates and rate certifications with regulatory agencies. Supports implementation of rates, new ..
Description The Associate Director, Problem, Incident and Event Management drives technical support teams to recover services during periods of service disruption or outages to key technology platforms/applications. The Associate Director, Problem, ..
Description Come join the Digital Health & Analytics (DH&A) team within Humana to build a world class Data Science and Insights enterprise capability leveraging digital-first platforms, analytics, and agile development methodologies. ..
