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Description The Risk Adjustment Representative 2 conducts quality assurance audits of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other ..
Description The Care Manager, Telephonic Nurse 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and ..
Description SeniorBridge is hiring a Per Diem Scheduler to cover On-Call hours as-needed. The On-Call Scheduling Specialist performs varied activities and moderately complex administrative/operational/customer support assignments, including paraprofessional scheduling and general ..
Description The Supervisor, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Supervisor, Compliance ..
Description iCare is seeking an Enrollment Specialist who will support the iCare enrollment processing duties for all lines of business including Medicare, Medicaid, Family Care Partnership (FCP) and BadgerCare Plus. Responsibilities ..
Description Job Description Summary Care Management Support Specialists contribute to the administration of care management. The CMSS provides non-clinical support to the assessment and evaluation of members' needs and requirements to ..
Description The UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on ..
Description The Supervisor, Pre-Authorization Nursing reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The Supervisor, Pre-Authorization ..
Job OverviewUnder guidance, controls the report generation process and provides guidance and support to clients daily or as a specialist on specific products/services.Essential Functionsu2022 Ensures the contract fulfillment to specifications of ..
Description The Medical Record Retrieval Specialist (Risk Adjustment Representative) travels to provider offices within the region and scans medical records into a secure system. The records are reviewed by Humana's Coding ..
Job Information Humana Clinical Pharmacy Lead, Remote in Glen Allen Virginia Description Be a part of an interactive team with broad exposure and scope within Humana. Humana is seeking a positive ..
... is looking for an experienced Healthcare Investigator to join its industry ... areas Bachelor's degree or significant healthcare fraud and investigation experience At ... At least 1 year of..
Job Information Humana Pre- Authorization Nursing Supervisor-- REMOTE/WORK AT HOME (Anywhere in the US) in Glen Allen Virginia Description The Supervisor, Pre-Authorization Nursing will be managing the team that reviews prior ..
Job Information Humana FP&A Lead, Medicaid Market in Glen Allen Virginia Description The Financial Planning & Analysis Lead is acritical leadership role with full market financial oversight over the South Carolina ..
Job Information Humana Senior Clinical Pharmacy Advisor, Clinical Program Innovation in Glen Allen Virginia Description The Senior Pharmacy Clinical Advisor will be part of an interactive team with broad exposure and ..
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 Responsibilities As part of the Service Fund Specialty Load Team, the Senior Provider Installation Professional will work directly with our national and market contracting teams to influence specialist contract terms ..
... looking for an experienced Senior Healthcare Investigator to join its industry ... Qualifications Bachelor's degree or significant healthcare fraud and investigation experience At ... At least 3 years of..
Description Care Management Support Specialists contribute to the administration of care management. The CMSS provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain ..
Performance Improvement Consultant - Healthcare Revenue Cycle Services Overview of ... cross-functional teams. The Performance Improvement Specialist will be responsible for monitoring ... experience in front/middle and back-end healthcare revenue..
... Certified Diabetes Care and Education Specialist-Remote-US in Glen Allen Virginia Description ... Certified Diabetic Care and Education Specialist (CDCES) delivers comprehensive and seamless ... Certified Diabetes Care and Education..
Description Do you thrive on working on the cutting edge? Working with innovators in the early stages of ideas, products, or platforms? Do you want to transform an industry? Crave new ..
