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...

Associate VP, Technology Solutions, Pharmacy - USA-MO-Springfield

Mon, 19 Jun 2023 00:00:00 CDT

Job Information Humana Associate VP, Technology Solutions, Pharmacy in Springfield Missouri Description The Associate Vice President of Technology Solutions acts as a liaison and collaborates with the...

Outpatient Medical Coding Auditor-Remote/Virtual in US - USA-MO-Springfield

Thu, 23 Mar 2023 00:00:00 CDT

Job Information Humana Outpatient Medical Coding Auditor-Remote/Virtual in US in Springfield Missouri Description The Medical Coding Auditor extracts clinical information from a variety of medical rec...

Inpatient Medical Coding Auditor-Remote/Virtual in US - USA-MO-Springfield

Thu, 23 Mar 2023 00:00:00 CDT

Job Information Humana Inpatient Medical Coding Auditor-Remote/Virtual in US in Springfield Missouri Description The Medical Coding Auditor extracts clinical information from a variety of medical reco...

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...

Quality Improvement Program Lead (National Medicaid Quality) - USA-MO-Springfield

Fri, 07 Apr 2023 00:00:00 CDT

Job Information Humana Quality Improvement Program Lead (National Medicaid Quality) in Springfield Missouri Description Humana Healthy Horizons is seeking a Quality Improvement Program Lead who will b...

Manager, Care Management Social Services-WAH Nationwide - USA-MO-Springfield

Sat, 06 May 2023 00:00:00 CDT

Job Information Humana Manager, Care Management Social Services-WAH Nationwide in Springfield Missouri Description Job Description Summary The Manager, Care Management leads teams of social work and s...

Fraud and Waste Investigator - Work At Home (Anywhere in the US) - USA-MO-Springfield

Mon, 05 Dec 2022 00:00:00 CST

Job Information Humana Fraud and Waste Investigator - Work At Home (Anywhere in the US) in Springfield Missouri Description Humana is looking for an experienced Healthcare Investigator to join its ind...

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...

AVP, MD, Stars and Risk Adjustment Clinical Strategy and Leadership - USA-MO-Springfield

Sun, 18 Dec 2022 00:00:00 CST

Job Information Humana AVP, MD, Stars and Risk Adjustment Clinical Strategy and Leadership in Springfield Missouri Description The Healthcare Quality Reporting & Improvement (HQRI) organization is see...

Senior Product Marketer, Primary Care - USA-MO-Springfield

Wed, 21 Dec 2022 00:00:00 CST

Description Humana's Primary Care Organization (PCO) is seeking a Senior Product Marketer to join working remote anywhere in the U.S. This marketing professional is responsible for the implementation...

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

Health Information Management Professional - USA-MO-Springfield

Mon, 17 Apr 2023 00:00:00 CDT

Description The Health Information Management Professional ensures data integrity for claims errors. The Health Information Management Professional work assignments are varied and frequently require ...

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

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

Thu, 20 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...

AVP, Stars and Risk Adjustment National Medical Director - USA-MO-Springfield

Mon, 01 May 2023 00:00:00 CDT

Job Information Humana AVP, Stars and Risk Adjustment National Medical Director in Springfield Missouri Description The Healthcare Quality Reporting & Improvement (HQRI) organization is seeking a tale...

Business Support Coordinator 1 - Medical Records - USA-MO-Springfield

Mon, 26 Jun 2023 00:00:00 CDT

Description Responsibilities The Business Support Coordinator 1 performs medical record content analysis to ensure compliance with requirements of the TRICARE contract. Prepare, scan, and stage for ...