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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 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 Humana Call Center Pharmacy Claims Technician in Lancaster South Carolina Description Job Description Summary The Pharmacy Claims Representative 2 adjudicates pharmacy claims and process pharmacy claims for payment. The ..
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 Manager, Fraud and Waste-Remote US in ... Lancaster South Carolina Description The Manager, Fraud and Waste conducts investigations ... fraudulent and abusive practices. The Manager, Fraud and..
Description The Claims Research & Resolution Professional 2 works with enterprise shares team comprised of calls/claims/contracting and external provider associates researching the resolution to a pending inquiry. Understands department, segment, and ..
Job Information Humana Process Improvement Lead South Carolina Medicaid (Utilization and Case Management) in Lancaster South Carolina Description The Process Improvement Lead analyzes, and measures the effectiveness of existing business processes ..
Job Information Humana Manager, Pharmacy and Medical Trend in Lancaster South Carolina Description This leader will oversee a team charged with monitoring, reporting and projecting Humana's drug trends, both pharmacy and ..
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 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 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 Senior Care Manager, Behavioral Health (BCBA) in Lancaster South Carolina Description Responsibilities The Senior Care Manager, Behavioral Health (BCBA) is responsible for the administration and monitoring of the ..
... 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 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, ..
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 ..
