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Description The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments ..
Description The Senior Value-Based Analyst supports successful value-based provider relationships with a focus on improving the provider experience and achieving path-to-value goals. The Senior Value-Based Analyst works on problems of diverse ..
Description The Senior Security Professional protects the organization's employees, properties, and all items of value on premises from any preventable harm or danger. The Senior Security Professional work assignments involve moderately ..
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 ..
Description The Senior Market Development Professional provides support to assigned health plan(s) relative to Behavioral Health RFPs, product implementations and operational support. The Senior Market Development Professional work assignments involve moderately ..
Job Information Humana Sales Support Representative in Riverton Wyoming Description Are you passionate about contributing to the well-being of the Medicare population? Would you like to provide support to an active ..
Description Are you passionate about contributing to the well-being of the Medicare population? Are you looking for a role that will let your creative ideas, relationship management and sales ability shine? ..
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 The Health Information Management Professional 2 ensures data integrity for claims errors. The Health Information Management Professional 2 work assignments are varied and frequently require interpretation and independent determination of ..
Job Information Humana Telephonic Behavioral Health Care Manager in Riverton Wyoming Description The Behavioral Health Care Manager, in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or ..
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 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 Behavioral Health Care Manager, in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness by guiding members/families toward resources appropriate for the ..
... is looking for an experienced Healthcare Investigator to join its industry ... areas Bachelor's degree or significant healthcare fraud and investigation experience At ... At least 1 year of..
Description The Provider Contracting Professional 2 initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements. The Provider Contracting Professional 2 work assignments are varied and frequently require interpretation ..
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 ..
Description The Network Operations Coordinator 3 manages provider data including but not limited to demographics and contract accuracy. Additional Information - How we Value You Benefits starting day 1 of employment ..
Description Humana Healthy Horizons in Florida is seeking a STARS Improvement Professional 2 who will develop, implement, and manage oversight of the company's Medicaid Stars Program. They will direct all quality ..
Description The Director, Clinical Pharmacy Drug Evaluation and Policy Strategies oversees drug class reviews/evaluation, clinical policy strategy development, research, P&T committee oversight, and accreditation. This position will work and collaborate with ..
Description The Care Management Support Assistant 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 ..
Description Humana is continuing to grow nationwide! We have 28 new Bilingual Medicaid Inbound Contact Representative openings that will have the pleasure of taking inbound calls from our Florida Medicaid Members ..
Description The Senior Learning Design Professional uses instructional design, cognitive psychology and adult learning theory to determine the appropriate solution in order to conduct or facilitate training courses for organization employees ..
