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Description The Utilization Management Behavioral Health Professional 2 utilizes ... benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work ... a Compact State The Utilization Management Behavioral Health..
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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 ..
... include data entry into medical management systems, assigning appropriate providers as necessary, ... Autism Services Navigator (ASN), Utilization Management professional or Manager for clinical ... into MSR and other..
Description The Manager, Utilization Management Nursing utilizes clinical nursing skills ... administration determinations. The Manager, Utilization Management Nursing works within specific guidelines ... goals. Responsibilities The Manager, Utilization Management Nursing..
... accuracy of formularies and utilization management (UM) criteria in the Formulary ... Collaborates with other pharmacists and healthcare professionals in a team environment ... an expert in Humana's formulary..
Description The Pre-Authorization Nurse 2 reviews Genetic testing prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The ..
... and possible participation in care management. The clinical scenarios predominantly arise ... health, or disease or care management. Medical Directors support Humana values, ... whether services provided by other..
... Director, Problem, Incident and Event Management drives technical support teams to ... Director, Problem, Incident and Event Management requires a solid understanding of ... Director, Problem, Incident and Event..
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 ..
... the Associate Director, IT Project Management, you will use your background ... background and experience in program management to lead and manage a ... The Associate Director, IT Project..
Description The Problem, Incident and Event Management Engineer 2 monitors trends in incidents and system issues and helps drive technical support teams to recover services during periods of service disruption or ..
Description The Care Management Support Assistant 3 contributes to ... contributes to administration of care management. Provides non-clinical support to the ... wellbeing of members. The Care Management Support Assistant..
... 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 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 ..
... care facility The Supervisor, Care Management Support will lead a team ... contributes to administration of care management. Provides non-clinical support to the ... of members. The Supervisor, Care..
... purpose is to provide care management program support resources to physicians, ... physicians, physician groups, and integrated healthcare delivery systems throughout the country. Healthcare isn't just about health anymore...
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 Responsibilities The Care Management Support Assistant 2- ACD Referral ... involves processing referrals into medical management system with emphasis on accuracy ... answer provider/beneficiary inquiries. The Care Management Support..
Description The Associate Director, Utilization Management Nursing utilizes clinical nursing skills ... determinations. The Associate Director, Utilization Management Nursing requires a solid understanding ... process. The Associate Director, Utilization Management..
