Healthcare Operations Jobs

We are immediately looking for an LPN or RN that is looking for full time, part-time, or PRN work in the Springfield area! Travel is required (mileage reimbursement included). For more ..

Job Information Humana Nurse Advice Line Telephonic Nurse 2 in Springfield Missouri Description The Care Manager, Telephonic Nurse 2 , in a telephonic environment, assesses and evaluates members' needs and requirements ..

Job Information Humana Manager, Behavioral Provider Contracting - Remote in Springfield Missouri Description The Manager, of Behavioral Health Provider Contracting communicates contract terms, payment structures, and reimbursement rates to providers and ..

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 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 ..

... and services. Partners closely with operations, vendors, customer success teams and/or ... insights Bachelor's degree in Business, Healthcare Administration or other related fields ... 50 market leader in integrated..

Job ID 21000GNRAvailable Openings 1Position Specific Information This position will cover the following clinics in the Springfield, Massachusetts area: Pioneer Valley Dialysis, Western Mass Kidney Center, East Springfield Dialysis, Palmer Dialysis, ..

Description Humana Special Needs Plans provide personalized guidance and resources to help members get the right care and information based on their specific condition or needs. Beneficiaries qualify with the following ..

Job Information Humana Medicaid Associate Director, Compliance Nursing in Springfield Missouri Description The Associate Director, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations ..

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 ..

Description Responsibilities Humana's Corporate Strategy team is a small, high-performing organization that works closely with Humana's senior leadership to chart the course for the company's future. Within Strategy Operations, you will ..

Description The Principal Quality Leader will lead testing and quality collaboration between Business and IT, guiding test strategies and tools and assure adherence to quality standards. Serves as point of contact ..

Job Information Humana Care Manager, Telephonic Behavioral Health 2 - Remote, US in Springfield Missouri Description Humana Military, a wholly-owned subsidiary of Humana Inc. headquartered in Louisville, KY, partners with the ..

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 The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within ..

Job Information Humana Senior Product Management Professional / Release Train Engineer in Springfield Missouri Description The Senior Product Management Professional / Release Train Engineer must be able to lead, plan and ..

Description As Humana's Medicaid membership continues to grow, the National Medicaid Clinical Operations team is expanding our shared services organization to enhance the clinical delivery process. The National Medicaid Director of ..

Description The Fraud Investigation Technician 2 conducts investigations of allegations of fraudulent and abusive practices. The Fraud Investigation Technician 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. ..

Description The Vendor Quality Medical Director will manage clinical vendor quality outcomes for Humana Clinical Operations Team. Responsibilities A full time Medical Director to manage clinical vendor quality outcomes for Humana ..

Job ID 21000GNSAvailable Openings 1Position Specific Information This position will cover the following clinics in the Springfield, Massachusetts area: Pioneer Valley Dialysis, Western Mass Kidney Center, East Springfield Dialysis, Palmer Dialysis, ..

Description Humana Military, a wholly-owned subsidiary of Humana Inc. headquartered in Louisville, KY, partners with the Department of Defense to administer the TRICARE health program for military members, retirees and their ..

Description The Network Operations Coordinator 4 maintains provider relations ... provider data needed for service operations. The Network Operations Coordinator 4 assumes ownership and ... and judgment. Responsibilities The Network..

Description The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management ..