THE LARGEST COLLECTION OF HEALTHCARE JOBS ON EARTH
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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..
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 ..
... 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 Director, Provider Contracting initiates, negotiates, and executes physician, hospital, ancillary and/or other provider contracts and agreements for an organization that provides health insurance. The Director, Provider Contracting requires ..
... 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,..
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 ..
Description The Senior Product Manager conceives of, develops, delivers, and manages products for customer use. The Senior Product Manager work assignments involve moderately complex to complex issues where the analysis of ..
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..
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. ..
... 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 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 ..
... 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 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 ..
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 ... departments, Humana colleagues and the..
... 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..
... 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 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 ..
... 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 .....
Description The Risk Adjustment Coder ensures coding is accurate and properly supported by clinical documentation within the health record. Follows state and federal regulations as well as internal policies and guidelines ..
... 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..
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 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, ..
