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Description Humana is seeking a Genetic Counselor to assist in the detecting and investigation of potential fraud and provide clinical guidance to the Special Investigators handling the cases. This is an ..
Description The Senior STARS Improvement Professional develops, implements, and manages oversight of the company's Medicare/Medicaid Stars Program. Directs all Stars quality improvement programs and initiatives. The Senior STARS Improvement Professional work ..
Description The Behavioral Health Clinical Advisor (Care Manager, Telephonic Behavior Health 2) will audit CPT (Current Procedural Terminology) codes to ensure correct billing under TOM (TRICARE Operations Manual) policies in accordance ..
Job Information Humana Healthcare Lead Product Manager: Chinese and Korean Segment Medicare Advantage in Tampa Florida Description The Lead Product Manager Conceives of, develops, delivers, and manages products for Chinese and ..
Description The Care Manager, Telephonic Behavioral Health 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 ..
Description The Process Improvement Professional 2 analyzes, and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Process Improvement Professional 2 work assignments ..
Description Market Development Advisor supports the Regional President, Humana Florida Medicaid, by leading strategic health plan initiatives in collaboration with senior health plan leaders and across the enterprise. This role partners ..
Description This is a salaried exempt position with responsibility for utilization management oversight and clinical decision-making as outlined in the Autism Care Demonstration (ACD) defined in the TRICARE Operations Manual Chapter ..
Description This role has responsibility for the oversight and monitoring of the Autism Care Demonstration (ACD) team performance to ensure compliance with contract and complex ACD policy requirements as defined by ..
Description Responsibilities The Associate Director for ACD Audit , at the director of the Director of Payment Integrity, will create and implement process improvement plans focused on the beneficiary and provider ..
Description The Genetic Counselor 2 responsible for evaluating and understanding member's risk of inherited medical condition. The Genetic Counselor 2 work assignments are varied and frequently require interpretation and independent determination ..
Description The Senior Claims Process & Policy Professional processes new insurance policies, modifications to existing policies, and claims forms. The Senior Claims Process & Policy Professional work assignments involve moderately complex ..
Description The Financial Reporting Lead prepares and distributes periodic financial statements for users other than those directly employed by the organization. The Financial Reporting Lead works on problems of diverse scope ..
Description The Behavioral Health Lead utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Behavioral Health Lead works on ..
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 ..
Description The Care Management Support Assistant 2 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 ..
Job Information Humana Clinical Provider Quality Improvement Field RN - Orange, Osceola, Polk County, FL in Tampa Florida Description The Senior Stars Improvement, Clinical Professional responsible for the development, implementation and ..
Description Responsibilities The ACD Referral Authorization Coordinator Lead role will assist the Supervisor in oversight & monitoring of processing and timeliness standards for referrals and authorizations under the Autism Care Demonstration ..
