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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 ..
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Job ID 21000KZ6Available Openings 1 PURPOSE AND SCOPE: Supports FMCNA’s mission,vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including followingall regulatory and FMS policy requirements. Functions ..
... is looking for an experienced Healthcare Investigator to join its industry ... enforcement authorities. Assembles evidence and documentation to support successful adjudication, where ... areas Bachelor's degree or significant..
Description The Director, Pharmacy Clinical Formulary and Medical Drug Strategies oversees and drives the pharmacy and medical drug formulary strategies across all lines of business (Medicare, Commercial, Medicaid). This position will ..
... looking for an experienced Senior Healthcare Investigator to join its industry ... enforcement authorities. Assembles evidence and documentation to support successful adjudication, where ... Qualifications Bachelor's degree or significant..
Description The Supervisor, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Supervisor, Compliance ..
Job Information Humana Medical Director - Medicare Pharmacy Appeals in Portland Maine Description The Medical Director relies on clinical background and reviews Medicare drug requests. The Medical director work assignments involve ..
Job Information Humana Medical Director - Medicare Pharmacy Appeals in Portsmouth New Hampshire Description The Medical Director relies on clinical background and reviews Medicare drug requests. The Medical director work assignments ..
Job Information Humana FP&A Lead, Medicaid Market in Portsmouth New Hampshire Description The Financial Planning & Analysis Lead is acritical leadership role with full market financial oversight over the South Carolina ..
Job Information Humana Pre- Authorization Nursing Supervisor-- REMOTE/WORK AT HOME (Anywhere in the US) in Portland Maine Description The Supervisor, Pre-Authorization Nursing will be managing the team that reviews prior authorization ..
Description The Care Manager, Telephonic Nurse 2 employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder ..
Description Responsibilities As part of the Service Fund Specialty Load Team, the Senior Provider Installation Professional will work directly with our national and market contracting teams to influence specialist contract terms ..
Job Information Humana Medicare Appeals and Grievance Medical Director in Portsmouth New Hampshire Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare ..
... Bonus - Limited Time Genesis HealthCare is one of the nation's ... the nation's leading providers of healthcare services from short-term to long-term ... relation to patient progress Maintain..
Description Job Description Summary 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 ..
Job Information Humana FP&A Lead, Medicaid Market in Portland Maine Description The Financial Planning & Analysis Lead is acritical leadership role with full market financial oversight over the South Carolina Medicaid ..
