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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 Humana's Primary Care Organization (PCO) is looking for an experienced and passionate Senior Product Marketing Professional to join the PCO's Field Marketing team. This is a remote role that will ..
Description The Care Manager, Telephonic Nurse 2 employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder ..
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 situations or data requires ..
Description The Medical Coding Coordinator 2 will process and apply the appropriate Code Edit claim payment reductions and denials based on software recommendation. The Medical Coding Coordinator 2 reviews submitted medical ..
Description Humana is a $90 billion (Fortune 40) market leader in integrated healthcare with a clearly defined purpose to help people achieve lifelong well-being. As a company focused on the health ..
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 ..
Job Information Humana Telephonic Behavioral Health Care Manager in Lancaster South Carolina Description The Behavioral Health Care Manager, in a telephonic environment, assesses and evaluates members' needs and requirements to achieve ..
Description The Data and Reporting Professional II generates ad hoc reports and regular datasets or report information for end-users using system tools and database or data warehouse queries and scripts. The ..
Job Information Humana Senior Copy Writer in Lancaster South Carolina Description Humana's The Hive is looking for a Senior Copy Writer to join the team! The Hive is Humana's in-house agency, ..
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 Bilingual Manager, Learning Facilitation , plans, coordinates, and implements all aspects of training programs for participants throughout for Grievance and Appeals / Careplus. EST states Responsibilities The Bilingual Grievances ..
Job Information Humana Senior FP&A Analyst in Lancaster South Carolina Description The Senior Financial Planning and Analysis Professional analyzes and forecasts financial, economic, and other data to provide accurate and timely ..
Description The Remote Systems Clinical Pharmacist will provide excellent customer service to both internal and external customers by developing and maintaining relationships with Account / Clinical Management and PCO-IPU Operations teams. ..
Job Information Humana RN, Senior Stars Improvement, Clinical Professional in Lancaster South Carolina Description Humana Healthy Horizons in Florida is seeking a RN, Senior Stars Improvement, Clinical Professional who will be ..
Job Information Humana Bilingual Quality Auditor in Lancaster South Carolina Description The Bilingual Quality Auditor/ Professional 2 ensures that products meet specific Centers for Medicaid and Medicare Services standards of quality. ..
Job Information Humana Senior Sales Enablement Product Marketer in Lancaster South Carolina Description Humana's Primary Care Organization (PCO) is looking for an experienced and passionate Product Marketer who is hyper customer ..
Description The Claims Research & Resolution Professional 2 works with enterprise shares team comprised of calls/claims/contracting and external provider associates researching the resolution to a pending inquiry. Understands department, segment, and ..
Job Information Humana Senior Innovation Portfolio Strategy Professional in Lancaster South Carolina Description The Humana Healthy Horizons Strategic Solutions team's purpose is to accelerate the ideation and development of transformational initiatives ..
Description The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations. The Behavioral Health Medical Director work assignments involve moderately complex to complex issues where the analysis of ..
Description The Director, Pharmacy Clinical Pipeline oversees the medical and pharmacy drug pipeline tracking and forecasting, supports financial sales analysis and market event news. This position will work and collaborate with ..
