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... conditions, by providing them with information, resources and tools which increase ... take charge of their own healthcare decisions. Provide guidance and clinical ... learn how to use virtual..
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Description The Process Improvement Lead analyzes, and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Process Improvement Lead works on problems of ..
... and courteous manner. Effectively communicate information with internal and external customers. ... established schedules and deadlines. Utilize information systems for maintenance and reporting issues. ... consistently providing complete and..
... take charge of their own healthcare decisions. Provide guidance and clinical ... coordinate interventions that may include information, education, resources and referrals Coordinate ... learn how to use virtual..
Description The UM Administration Coordinator contributes to administration of utilization management. The UM Administration Coordinator performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. ..
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 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 ..
... Facility to obtain sufficient clinical information for all levels of facility ... operations experience Knowledge of Humana systems and clinical programs Additional Information Interview Format As part of .....
... phone to gather additional clinical information or discuss determinations regularly, and ... whether services provided by other healthcare professionals are in agreement with ... departments, Humana colleagues and the..
... look for a Senior Business Systems Analyst to join working remote ... the US! The Senior Business Systems Analyst performs analysis of business, ... requirement specifications. The Senior Business..
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 ..
... Administration support experience in a healthcare industry Familiarity with care and ... a contracting process, preferably in healthcare Effective negotiation skills Ability to ... learn new HR and reporting..
... get the right care and information based on their specific condition ... related experience in management of healthcare analytical support staff Technical proficiency ... for optimal performance from Humana..
Description The Senior Claims Research & Resolution Professional manages claims operations that involve customer contact, investigation, and settlement of claims for and against the organization. Approves all claims issues/complaints within contractual ..
... phone to gather additional clinical information or discuss determinations regularly, and ... whether services provided by other healthcare professionals are in agreement with ... management organizations, hospitals/ Integrated Delivery..
... into prepayment status. 30% Update systems with corrections to provider records ... Qualifications 2 plus years of healthcare experience Prior experience in Fraud, ... or Master's Degree in Business,..
... physicians, physician groups, and integrated healthcare delivery systems throughout the country. Healthcare isn't just about health anymore. ... of our members, and the healthcare industry as a whole. Responsibilities..
... indicators The CMSA2 leverages phone systems, computer programs, documentation processes, workflows ... Administrative support experience in the healthcare industry Bilingual in Spanish highly ... in Spanish highly desired Additional..
Job Information Humana Social Worker-MSW and licensure ... for optimal performance from Humana systems is 25M x 10M Associates ... (see details below under Additional Information) and upon offer will..
... can complete or request additional information. Role Responsibilities Recognizes specific assessments/treatment ... civilian providers to obtain additional information that may be required to ... Processing) . Two years prior..
Description The Director, Provider Contracting- Behavioral Health Medicaid initiates, negotiates, and executes physician, hospital, and/or other provider behavioral health contracts for an organization that provides managed Medicaid health insurance. Requires an ..
Description The Clinical Data and Reporting Professional 2 generates ad hoc reports and regular datasets and reporting for clinical leadership decision making. The Clinical Data and Reporting Professional 2 also pulls ..
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, ..
