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... customers Thought Leaders (TL) and Healthcare Providers (HCP) within assigned geography. ... local procedures, company ethical and legal guidelines and directives • Actively ... Actively assess the medical and..
Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part C Line of Business. The Medical Director provides medical interpretation and determinations ..
Description Humana's Primary Care Organization (PCO) is looking for an experienced and passionate Senior Product Marketing Professional to join the PCO's Field Marketing team. This is a remote role that will ..
Description The Oncology Staff Utilization Management Pharmacist is a clinical pharmacist who completes medical necessity and comprehensive medication reviews for prescriptions requiring pre-authorization, with a focus on oncology requests. The Oncology ..
Description The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All ..
... senior-focused health care or Humana Healthcare Services High sense of accountability ... high impact projects, experience - Healthcare Industry Experience in data analytics ... Power Point, Word, Outlook) 1..
Description The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Medical Coding ..
Description The mission of the Physician Performance Insights team is to empower Humana members to make informed healthcare decisions. Our key goal is to ensure transparency and help our members obtain ..
Description The Senior Pharmacy Clinical Advisor is an integral part of the Pharmacy Stars team which is accountable for Humana's medication related Star measure performance. The Senior Pharmacy Clinical Advisor develops ..
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. Responsibilities ..
Job Information Humana RN Care Manager, Telephonic Nurse (Bilingual) - Puerto Rico in San Juan Puerto Rico Description This is a Work-At-Home position located in Puerto Rico. You must be fully ..
Description The Provider Contracting Professional initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Provider Contracting Professional work assignments are ..
... 40) market leader in integrated healthcare with a clearly defined purpose ... we are seeking an accomplished healthcare leader for the newly-created role ... quality, appropriate, and cost-effective behavioral..
Description The Supervisor, Care Management Support contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness ..
PURPOSE AND SCOPE:Supports the training and education of employees based in company facilities and programs within an assigned geographical area. Delivers standardized, competency based, training and development programs including new employee ..
Description Humana is a Fortune 60 market leader in integrated healthcare whose dream is to help people achieve lifelong well-being. As a company focused on the health and well-being of the ..
Description You have the unique opportunity to build a technology team for one of the fastest-growing e-commerce companies in the Clinical care management and make a difference in our members' lives. ..
Description The DRG Validation Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM and PCS) to patient records. The Medical ..
Description The Health Information Management Professional ensures data integrity for claims errors. The Health Information Management Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate ..
Description The Manager, Fraud and Waste, Genetic Counseling provides clinical support for investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste, Genetic Counseling works within specific guidelines ..
Description The Data and Reporting Professional II generates ad hoc reports and regular datasets or report information for end-users using system tools and database or data warehouse queries and scripts. The ..
... Marketing team. As a senior-focused healthcare provider, and subsidiary of one ... Experience in Financial Services, FinTech, Healthcare, HealthTech, Technology, Professional Services, or ... Business Experience working in the..
