HealthcareCrossing Jobs

Commercial Medical Director - Work At Home - USA-MO-Springfield

Mon, 26 Jun 2023 00:00:00 CDT

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...

Medical Director - Florida Medicaid - USA-MO-Springfield

Thu, 23 Mar 2023 00:00:00 CDT

Job Information Humana Medical Director - Florida Medicaid in Springfield Missouri Description The Medical Director relies on medical background and reviews health claims. The Medical Director work as...

RN Case Manager - Telephonic Nurse 2 - Complex Case Management Program (Remote) - USA-MO-Springfield

Fri, 07 Apr 2023 00:00:00 CDT

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 mem...

Medical Director - South East Region - USA-MO-Springfield

Wed, 02 Nov 2022 00:00:00 CDT

Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situ...

Director, Medicaid Strategic Solutions - USA-MO-Springfield

Wed, 02 Nov 2022 00:00:00 CDT

Job Information Humana Director, Medicaid Strategic Solutions in Springfield Missouri Description Humana Medicaid is seeking exceptional candidates to join our Medicaid Product Strategy & Optimization...

Referrals Coordinator - USA-MO-Springfield

Fri, 02 Dec 2022 00:00:00 CST

Description The Referrals Coordinator 2 processes referrals from Civilian providers. The Referrals Coordinator 2 performs varied activities and moderately complex administrative/operational/customer ...

Nurse Advice Line Telephonic Nurse - RN Compact License States Only - USA-MO-Springfield

Mon, 05 Dec 2022 00:00:00 CST

Job Information Humana Nurse Advice Line Telephonic Nurse - RN Compact License States Only in Springfield Missouri Description The Care Manager, Telephonic Nurse 2 , in a telephonic environment, asses...

Utilization Management & Medical Coding Registered Nurse, RN - USA-MO-Springfield

Fri, 16 Dec 2022 00:00:00 CST

Description The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determin...

Behavioral Health Medical Director - USA-MO-Springfield

Fri, 23 Dec 2022 00:00:00 CST

Description The Behavioral Health Medical Director makes determinations regarding prior authorization and retrospective reviews for inpatient and outpatient services to ensure that members receive cl...

Medical Director-KY Medicaid - USA-MO-Springfield

Sun, 25 Dec 2022 00:00:00 CST

Description The Medical Director's primary responsibility is the review of medical authorizations or claims to determine the medical necessity of a given service or level of care. The Medical Directo...

Certified Registered Nurse Anesthetist CRNA or AA - Springfield Missouri - USA-MO-Springfield

Sat, 07 Jan 2023 00:00:00 CST

Grievances and Appeals Medical Director - Nationwide - USA-MO-Springfield

Sat, 22 Apr 2023 00:00:00 CDT

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 interp...

Medical Director - Claims Management - USA-MO-Springfield

Thu, 20 Apr 2023 00:00:00 CDT

Medical Director - South Central - USA-MO-Springfield

Thu, 20 Apr 2023 00:00:00 CDT

Medical Director - Behavioral Health - Tricare - USA-MO-Springfield

Thu, 20 Apr 2023 00:00:00 CDT

Grievances and Appeals Medical Director - Weekends Required - USA-MO-Springfield

Thu, 20 Apr 2023 00:00:00 CDT

DoD SkillBridge, Military Spouse, Care Management, Registered Nurse - USA-MO-Springfield

Thu, 20 Apr 2023 00:00:00 CDT

Description The Intern - Care Manager, Registered Nurse, RN performs varied activities moderately complex administrative/operational/member support and semi-routine assignments to support the busines...

Behavioral Health Medical Director - Tricare - USA-MO-Springfield

Fri, 28 Apr 2023 00:00:00 CDT

Description The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations. The Behavioral Health Medical Director work assignments involve moderately comple...

Data Engineer Marketing Platforms - USA-MO-Springfield

Sat, 13 May 2023 00:00:00 CDT

Description Humana is a Fortune 60 market leader in integrated healthcare whose dream is to help people achieve lifelong well-being. As a company focused on the health and well-being of the people we...

Telephonic Psychiatric RN Care Manager - USA-MO-Springfield

Wed, 24 May 2023 00:00:00 CDT

Description The Behavioral Health Care Manager, Telephonic Nurse, in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state...