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Description The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within ..
Job Information Humana Inpatient Medical Coding Auditor (MSDRG/ APDRG)-Remote/Virtual in US in Riverton Wyoming Description The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate ..
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 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 Information Humana Medicare/Medicaid Program Manager -- Remote in Riverton Wyoming ... looking for an experienced Program Manager (internally known as an Acquisition ... contracts. As a Medicaid/Medicare Program Manager..
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 ..
Job Information Humana RN, Senior Stars Improvement, Clinical Professional in Riverton Wyoming Description Humana Healthy Horizons in Florida is seeking a RN, Senior Stars Improvement, Clinical Professional who will be responsible ..
Job Information Humana Actuary, Analytics/Forecasting in Riverton Wyoming Description The Actuarial Product Manager manages the ecosystem of actuarial tools, models, and methodology for a focused yet complex subset of the Individual ..
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, ..