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Job Information Humana Medicaid Associate Director, Compliance Nursing in Salem Oregon Description The Associate Director, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations ..
Description The Pharmacy Claims Lead operationalizes and monitors Coordination of Benefits (COB) and subrogation claim processing logic and processes. Exercises independent judgment and decision making on managing staff, complex issues regarding ..
Description The Senior Claims Research & Resolution Professional manages claims operations that involve customer contact, investigation, and settlement of claims for and against the organization. Approves all claims issues/complaints within contractual ..
Job Information Humana RN, Senior Stars Improvement, Clinical Professional in Salem Oregon Description Humana Healthy Horizons in Florida is seeking a RN, Senior Stars Improvement, Clinical Professional who will be responsible ..
Description The Medical Director's primary responsibility is the review of medical authorizations or claims to determine the medical necessity of a given service or level of care. The Medical Director's work ..
Description The Senior Market Development Professional provides support to assigned health plan(s) relative to Behavioral Health RFPs, product implementations and operational support. The Senior Market Development Professional work assignments involve moderately ..
Job Information Humana Associate Director, Health Information Management in Salem Oregon Description The Associate Director, Health Information Management ensures data integrity and quality for our encounter submissions systems. The Associate Director, ..
... Qualifications Bachelor's degree in a healthcare field or equivalent experience. 5 ... years of experience in managed healthcare analysis, preferably as a Business ... analysis, preferably as a Business..
Description The mission of the Physician Performance Insights team is to empower Humana members to make informed healthcare decisions. Our key goal is to ensure transparency and help our members obtain ..
Description The Health Information Management Professional ensures data integrity for claims errors. The Health Information Management Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate ..
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 ..
... Humana Lead Product Manager - Healthcare API in Salem Oregon Description ... The Lead Product Manager - Healthcare API (SME) as part of ... Individual will be leveraging previous..
Job Information Humana Manager, Pharmacy and Medical Trend in Salem Oregon Description This leader will oversee a team charged with monitoring, reporting and projecting Humana's drug trends, both pharmacy and medical, ..
... 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..
Job Information Humana UM Medical Director - Conviva in Salem Oregon Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..
Job Information Humana Network Operations Lead - Behavioral Health/Medicaid in Salem Oregon Description The Network Operations Lead maintains provider relations to support customer service activities through data integrity management and gathering ..
Job Information Humana Medical Director of Trend Analytics in Salem Oregon Description Humana's ECM organization is seeking a Medical Director of Trend Analytics. As a clinical trend leader you will support ..
... 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 Medical Director - S. Florida in Salem Oregon Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..
Job Information Humana Senior Process Improvement Professional (HealthCare, Provider Value exp.) Work at Home in Salem Oregon Description The Senior Process Improvement Professional analyzes, and measures the effectiveness of existing business ..
Job Information Humana Medical Director - Florida Medicaid in Salem Oregon Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..
