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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 ..
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 ..
Job Information Humana UM Medical Director - Conviva in Charlotte North Carolina Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately ..
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 ..
Job Information Humana Manager, Fraud and Waste-Remote US in ... Charlotte North Carolina Description The Manager, Fraud and Waste conducts investigations ... fraudulent and abusive practices. The Manager, Fraud and..
... 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..
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 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 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 ..
Job Information Humana Senior Care Manager, Behavioral Health (BCBA) in Charlotte North Carolina Description Responsibilities The Senior Care Manager, Behavioral Health (BCBA) is responsible for the administration and monitoring of the ..
Description The Associate Director, Payment Integrity uses technology and data mining, detects anomalies in data to identify and collect overpayment of claims. Contributes to the investigations of fraud waste and our ..
Job Information Centerwell Director Clinical Ops & Services Home Health in Charlotte North Carolina As a Clinical Operations and Services Director, Home Health ; you will: Direct sales/marketing activities within an ..
Description Humana's Enterprise Clinical Management team needs your clinical, business and analytics acumen to solve for the healthcare challenges of today. The Clinical Analytics and Trend team uses advanced scientific techniques, ..
Job Information Humana Manager, Pharmacy and Medical Trend in Charlotte North Carolina Description This leader will oversee a team charged with monitoring, reporting and projecting Humana's drug trends, both pharmacy and ..
Job Information Humana Process Improvement Lead South Carolina Medicaid (Utilization and Case Management) in Charlotte North Carolina Description The Process Improvement Lead analyzes, and measures the effectiveness of existing business processes ..
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 ..
