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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 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 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 ..
Job Information Humana Manager, Pharmacy and Medical Trend in Las Vegas Nevada Description This leader will oversee a team charged with monitoring, reporting and projecting Humana's drug trends, both pharmacy and ..
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 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 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 UM Medical Director - Conviva in Las Vegas Nevada Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately ..
Job Information Humana Manager, Fraud and Waste-Remote US in ... Las Vegas Nevada Description The Manager, Fraud and Waste conducts investigations ... fraudulent and abusive practices. The Manager, Fraud and..
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 ..
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 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 ..
... of the MRA team, the Manager will work closely with market ... based on advanced knowledge/experience. The Manager, Risk Adjustment works within specific ... approach, resources, schedules and goals.The..
... of services provided by other healthcare professionals in compliance with review ... issues regarding technical approach for project components, and work is performed ... Delivery Systems, health insurance, other..
