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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..
COMPANY OVERVIEW Knoll, Inc. is a constellation of design-driven brands and people, working together with our clients in person and digitally to create inspired modern interiors. Our internationally recognized portfolio includes ..
Job Information Humana Manager, Pharmacy and Medical Trend in Pittsburgh Pennsylvania Description This leader will oversee a team charged with monitoring, reporting and projecting Humana's drug trends, both pharmacy and medical, ..
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, Fraud and Waste-Remote US in ... in Pittsburgh Pennsylvania Description The Manager, Fraud and Waste conducts investigations ... fraudulent and abusive practices. The Manager, Fraud and..
Job Information Humana Call Center Pharmacy Claims Technician, Remote in Pittsburgh Pennsylvania Description The Pharmacy Claims Representative 2 adjudicates pharmacy claims and process pharmacy claims for payment. The Pharmacy Claims Representative ..
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,..
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 ..
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 ..
Job Information Humana Manager, Fraud and Waste-Remote US in ... in Philadelphia Pennsylvania Description The Manager, Fraud and Waste conducts investigations ... fraudulent and abusive practices. The Manager, Fraud and..
... 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..
Job Information Humana Call Center Pharmacy Claims Technician in Pittsburgh Pennsylvania Description Job Description Summary The Pharmacy Claims Representative 2 adjudicates pharmacy claims and process pharmacy claims for payment. The Pharmacy ..
Medical Coding Claim Edit and Denial Specialist Job ... immediate need for a full-time Claim Edit and Denial Specialist. Responsibilities ... position is responsible for resolving claim edits and rejections..
Description Job Description Summary 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 ..
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 Pittsburgh Pennsylvania Description Responsibilities The Senior Care Manager, Behavioral Health (BCBA) is responsible for the administration and monitoring of the Autism ..
