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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 ..
Description CenterWell Senior Primary Care, a subsidiary of Humana Inc., is the new brand for a primary care medical group practice with centers open or opening in Florida, Georgia, Kansas, Louisiana, ..
... facility The Supervisor, Care Management Support will lead a team of ... a team of 16-22 care support professionals and contributes to administration ... of care management. Provides non-clinical..
Description The UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on ..
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 ..
... Job Description Summary Care Management Support Specialists contribute to the administration ... management. The CMSS provides non-clinical support to the assessment and evaluation ... and wellbeing of members. The..
... looking for an experienced Senior Healthcare Investigator to join its industry ... Assembles evidence and documentation to support successful adjudication, where appropriate. Conducts ... Qualifications Bachelor's degree or significant..
Description The Director, Pharmacy Clinical Formulary and Medical Drug Strategies oversees and drives the pharmacy and medical drug formulary strategies across all lines of business (Medicare, Commercial, Medicaid). This position will ..
Description The Supervisor, Care Management Support contributes to administration of care ... of care management. Provides non-clinical support to the assessment and evaluation ... members. The Supervisor, Care Management Support..
Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health episodic and per diem requests. The Medical Director provides medical interpretation and determinations whether ..
Description Humana's Marketing organization is seeking an experienced Market Research Lead to join the Market Research Department working remote anywhere in the U.S. This is a newly added role that will ..
Description Care Management Support Specialists contribute to the administration ... management. The CMSS provides non-clinical support to the assessment and evaluation ... and wellbeing of members. The Support Specialist performs..
Description The Care Manager, Telephonic Nurse 2 employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder ..
... analytics. o Provide Market leader support reporting out on financial results, ... analysis for new contracts and support negotiations o Develop Market specific ... development o Provide leadership and..
Description The Lead Behavioral Health Medical Director oversees the work of 2 Medical Directors who conduct clinical case reviews of the care received by members in an assigned market, member population, ..
... techniques, and analytical approach. Must support compliance related functions under the ... and holidays as applicable) to support the needs of the business ... the business Provides oversight, education,..
Description Responsibilities As part of the Service Fund Specialty Load Team, the Senior Provider Installation Professional will work directly with our national and market contracting teams to influence specialist contract terms ..
Description iCare is seeking an Enrollment Specialist who will support the iCare enrollment processing duties for all lines of business including Medicare, Medicaid, Family Care Partnership (FCP) and BadgerCare Plus. Responsibilities ..
Job Information Humana Pre- Authorization Nursing Supervisor-- REMOTE/WORK AT HOME (Anywhere in the US) in Fargo North Dakota Description The Supervisor, Pre-Authorization Nursing will be managing the team that reviews prior ..
Description The Supervisor, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Supervisor, Compliance ..
... is looking for an experienced Healthcare Investigator to join its industry ... Assembles evidence and documentation to support successful adjudication, where appropriate. Conducts ... areas Bachelor's degree or significant..
