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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 ..
Description The Care Manager, Telephonic Behavioral Health 2 , ... wellbeing of members. The Care Manager, Telephonic Behavioral Health 2 work ... of action. Responsibilities The Care Manager, Telephonic Behavioral..
Description Responsibilities The Care Manager, Behavioral Health 2 (BCBA) is responsible for the administration and monitoring of the Autism Care Demonstration (ACD) including coordination of services for ABA Therapy, benefits provided ..
... immediate need for a full-time Claim Edit and Denial Specialist. Responsibilities ... position is responsible for resolving claim edits and rejections related to ... experience working facility coding related..
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 ..
Job Information Humana Senior Care Manager, Behavioral Health (BCBA) in Cincinnati Ohio Description Responsibilities The Senior Care Manager, Behavioral Health (BCBA) is responsible for the administration and monitoring of the Autism ..
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 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 The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All ..
Description Humana Healthy Horizons in Indiana is seeking a Provider Services Advisor (Market Development Advisor) who will be responsible for the strategic and tactical support of the Provider Services team. They ..
Job Information Humana Manager, Pharmacy and Medical Trend in Cincinnati Ohio Description This leader will oversee a team charged with monitoring, reporting and projecting Humana's drug trends, both pharmacy and medical, ..
Job Information Humana Call Center Pharmacy Claims Technician, Remote in Cincinnati Ohio Description The Pharmacy Claims Representative 2 adjudicates pharmacy claims and process pharmacy claims for payment. The Pharmacy Claims Representative ..
Description Assist local pharmacies with claims adjudication to support medication access for HC & LTC hospice patients; reconcile historic billing issues. Responsibilities There are 4 shifts available for this role. All ..
Description The Manager, Fraud and Waste, Genetic Counseling provides clinical support for investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste, Genetic Counseling works within specific guidelines ..
Description The Senior Product Manager role is a part of ... customer use. The Senior Product Manager will need to build relationships ... home anywhere The Senior Product Manager ideates,..
... KEY ACCOUNTABILITIES Process Improvement and Project Management Contributes to the identification ... projects, key insights, and ensure project milestones and deliverables are implemented ... manner Develops and manages detailed..
Job Information Humana Manager, Fraud and Waste-Remote US in ... in Cincinnati Ohio Description The Manager, Fraud and Waste conducts investigations ... fraudulent and abusive practices. The Manager, Fraud and..
