Government Jobs

Description Responsibilities The Associate Director for ACD Audit , at the director of the Director of Payment Integrity, will create and implement process improvement plans focused on the beneficiary and provider ..

Description This role has responsibility for the oversight and monitoring of the Autism Care Demonstration (ACD) team performance to ensure compliance with contract and complex ACD policy requirements as defined by ..

Description The Referrals Coordinator 2 process referrals from Military Treatment Facilities (MTFs) and civilian providers. The Referrals Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically ..

Job Information Humana Supervisor, Credentialing in Dover Delaware Description Responsibilities The Supervisor, Credentialing Operations is responsible for supervising activities associated with certification and recertification of providers in the TRICARE East Region. ..

Job Information Humana Medical Director - Texas in Dover Delaware Description The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of ..

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

Job Information Humana Medicare Appeals and Grievance Medical Director in Dover Delaware Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part ..

Job Information Humana Medical Director - Medicare Pharmacy Appeals in Dover Delaware Description The Medical Director relies on clinical background and reviews Medicare drug requests. The Medical director work assignments involve ..

Job Information Humana Senior Technology Implementation Professional (Remote-Nationwide) in Dover Delaware Description The Senior Technology Implementation Professional delivers new technological solutions to meet business needs within a specified scope while aligned ..

Job Information Humana UM Medical Director - Conviva in Dover Delaware Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..

Job Information Humana Manager, Credentialing in Dover Delaware Description Responsibilities The Manager, Certifications Operations reviews the applicant's education, training, clinical experience, licensure, accreditation, certifications, professional liability insurance, and other TRICARE requirements ..

Job Information Humana Bilingual Quality Auditor in Dover Delaware Description The Bilingual Quality Auditor/ Professional 2 ensures that products meet specific Centers for Medicaid and Medicare Services standards of quality. Review ..

Job Information Humana Director, Informatics in Dover Delaware Description The Director, Informatics coordinates with other analytics, IT and business areas across the organization to ensure work is completed with insights from ..

Job Information Humana Medical Coding Auditor - Outpatient & Surgical Specialty Coding Team-Remote in US in Dover Delaware Description The Medical Coding Auditor reviews medical claims submitted against medical records provided, ..

Job Information Humana Medical Director - National Medicare Team in Dover Delaware Description The Medical Director relies on medical background and reviews preauthorization requests for services. The Medical Director work assignments ..

Job Information Humana Senior Data Manager - Primary Care Organization in Dover Delaware Description The Senior Data Manager supports all aspects of configuration control, data management, and deficiency reporting. The Senior ..

Job Information Humana Data Manager / ETL Developer - Primary Care Organization in Dover Delaware Description The Data Manager 2 supports all aspects of configuration control, data management, and deficiency reporting. ..

Job Information Humana Market Development Advisor - Medicaid Provider Service Operations in Dover Delaware Description The Market Development Advisor - Medicaid Provider Service Operations provides support to assigned health plan and/or ..

Job Information Humana Director, State Public Policy in Dover Delaware Description The Director of State Public Policy role resides in Humana's Corporate Affairs department and is charged primarily with public policy ..

Job Information Humana Manager, Utilization Management RN - Remote in Dover Delaware Description The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical ..

Job Information Humana Senior Fraud and Waste Investigator-- REMOTE/WORK AT HOME in Dover Delaware Description Humana is looking for an experienced Senior Healthcare Investigator to join its industry leading Special Investigations ..

Job Information Humana Utilization Management Registered Nurse - Remote in Dover Delaware Description The Utilization Management Nurse utilizes clinical nursing skills to support the coordination, documentation and communication of medical services ..

Job Information Humana Marketing Campaign Developer in Dover Delaware Description Responsibilities The Marketing Campaign Developer supports Humana Military email and Text marketing projects as assigned. As a communications developer you are ..