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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 ..
Description Risk Adjustment Coders are responsible for reviewing medical records, completing multiple audits, and special projects. Associates in this role work collaboratively with other departments. Responsibilities The Risk Adjustment Coder ensures ..
Description The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments ..
Job Information Humana Medical Director - S. Florida in Meridian Idaho Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..
Job Information Humana Medical Director - Medicare Pharmacy Appeals in Meridian Idaho Description The Medical Director relies on clinical background and reviews Medicare drug requests. The Medical director work assignments involve ..
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 ..
Job Information Humana FP&A Lead, Medicaid Market in Meridian Idaho Description The Financial Planning & Analysis Lead is acritical leadership role with full market financial oversight over the South Carolina Medicaid ..
... Certified Diabetes Care and Education Specialist-Remote-US in Meridian Idaho Description The ... Certified Diabetic Care and Education Specialist (CDCES) delivers comprehensive and seamless ... Certified Diabetes Care and Education..
Job Information Humana Clinical Formulary Strategy Pharmacist - Work At Home in Meridian Idaho Description Responsibilities The Clinical Formulary Strategy Pharmacist monitors drug development pipeline, and medical literature, while providing clinical ..
... 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..
Job Information Humana Senior Clinical Pharmacy Advisor, Clinical Program Innovation in Meridian Idaho Description The Senior Pharmacy Clinical Advisor will be part of an interactive team with broad exposure and scope ..
Description The Clinical Pharmacy Lead for Pharmacy trend will be a part of an interactive team with broad exposure and scope within Humana. Humana is seeking a positive and proactive individual ..
Job Information Humana Pre- Authorization Nursing Supervisor-- REMOTE/WORK AT HOME (Anywhere in the US) in Meridian Idaho Description The Supervisor, Pre-Authorization Nursing will be managing the team that reviews prior authorization ..
... of coding practices and clinical documentation, grievance and appeals processes, and ... whether services provided by other healthcare professionals are in agreement with ... Delivery Systems, health insurance, other..
Job Information Humana Medicare Appeals and Grievance Medical Director in Meridian Idaho Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part ..
... CMS requirements by analyzing physician documentation and interpreting into ICD10 diagnoses ... correct Risk Adjustment coding including documentation improvement, provider education, analyzing reports, ... work experience with Coding and/or..
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 ..
... of services provided by other healthcare professionals in compliance with review ... whether services provided by other healthcare professionals are in agreement with ... Delivery Systems, health insurance, other..
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 ..
... whether services provided by other healthcare professionals are in agreement with ... whether services provided by other healthcare professionals are in agreement with ... Delivery Systems, health insurance, other..
Description The Provider Contracting Executive initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements. The Provider Contracting Executive engages in strategic negotiation and relationship-building with a variety of ..
