HealthcareCrossing Jobs

Quality Improvement Nurse (Work at Home KS, AR, OK, MO, NE, IA) - USA-MO-Springfield

Mon, 04 Sep 2023 00:00:00 CDT

Description The Senior Stars Improvement, Clinical Professional responsible for the development, implementation and management oversight of the company's Medicare/Medicaid Stars Program. The Senior S...

RN -Utilization Management Nurse (Medicare) - Work at home (Eastern Time zone hours)- Southeast Region (GA/SC) - USA-MO-Springfield

Tue, 15 Aug 2023 00:00:00 CDT

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

SeniorBridge Home Care Scheduler/Referral Coordinator-Work at home nationwide - USA-MO-Springfield

Sun, 10 Sep 2023 00:00:00 CDT

Description The Referral Coordinator 2 schedules and pre-registers patients for exams and procedures with specialists and providers outside of the primary care physician's office. The Referral Coordi...

Utilization Management Nurse 2 - Work at Home (Part-Time - Tuesday/Thursday/Friday) - USA-MO-Springfield

Tue, 08 Aug 2023 00:00:00 CDT

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...

Utilization Management Nurse 2 - Central Region (Work at Home - KS, AR, MO, OK, IA, NE) - USA-MO-Springfield

Tue, 12 Sep 2023 00:00:00 CDT

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...

RN - Pre Auth/Utilization Management Nurse 2 - GA/SC region - USA-MO-Springfield

Mon, 26 Jun 2023 00:00:00 CDT

Director, National Medicaid Care Management Strategy and Practice - USA-MO-Springfield

Mon, 26 Jun 2023 00:00:00 CDT

Description As Humana's Medicaid membership continues to grow, the National Medicaid Clinical Operations team is expanding our shared services organization to enhance the clinical delivery process. T...

Actuary, Analytics/Forecasting, Individual Dental and Vision - USA-MO-Springfield

Mon, 26 Jun 2023 00:00:00 CDT

Description The Actuary, Analytics/Forecasting will develop the financial forecast for the dental and vision benefits included within Humana's growing Medicare Advantage business, as well as pricing ...

Associate Director, Problem, Incident and Event Management - USA-MO-Springfield

Mon, 26 Jun 2023 00:00:00 CDT

Description The Associate Director, Problem, Incident and Event Management drives technical support teams to recover services during periods of service disruption or outages to key technology platfor...

Utilization Management RN (DME / HH Outpatient) - WAH - USA-MO-Springfield

Mon, 26 Jun 2023 00:00:00 CDT

Corporate Strategist - USA-MO-Springfield

Mon, 26 Jun 2023 00:00:00 CDT

Description Responsibilities Humana's Corporate Strategy team is a small, high-performing organization that works closely with Humana's senior leadership to chart the course for the company's future...

Nurse Auditor 2/RN (Coding and Home Health Field exp a MUST) Work At Home - USA-MO-Springfield

Sun, 13 Aug 2023 00:00:00 CDT

Description The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate...

Manager, Utilization Management Nursing - Medicare / Medicaid - USA-MO-Springfield

Fri, 04 Aug 2023 00:00:00 CDT

Job Information Humana Manager, Utilization Management Nursing - Medicare / Medicaid in Springfield Missouri Description The Manager, Utilization Management Nursing utilizes clinical nursing skills to...

Physician Strategy Sr. Professional - USA-MO-Springfield

Fri, 23 Jun 2023 00:00:00 CDT

Description Humana is seeking a Physician Strategy Sr. Professional to join our growing team. The Physician Strategy professional will be responsible for setting and implementing strategy for interna...

RN, Utilization Management - Behavioral Health - USA-MO-Springfield

Fri, 23 Jun 2023 00:00:00 CDT

Description Full-Time Remote, Telephonic RN opportunity. The Utilization Management Behavioral Health Nurse utilizes behavioral health knowledge and skills to support the coordination, documentation...

Physician Assistant III - Ortho Pediatrics - Springfield - USA-MO-Ozark

Fri, 23 Jun 2023 00:00:00 CDT

Ortho Pediatrics

Associate Director, Accreditation - USA-MO-Springfield

Fri, 23 Jun 2023 00:00:00 CDT

Description Humana is seeking an experienced and dynamic Associate Director of Accreditation to manage a team of subject matter experts on NCQA Health Plan Accreditation and NCQA Health Equity Accred...

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 ...

Enterprise Clinical Operating Model (ECOM) Intern - USA-MO-Springfield

Mon, 26 Jun 2023 00:00:00 CDT

Description The Intern - General 2 performs duties in field of study or profession. The Intern - General 2 performs varied activities and moderately complex administrative/operational/customer suppor...