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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 ..
... leadership. Our Department of Defense Contract requires U.S. citizenship for this ... Qualifications Our Department of Defense Contract requires U.S. citizenship for this ... Qualifications 2 plus years of..
Description Responsibilities This role within the Autism Care Demonstration (ACD) Team, will work closely with Care Management leaders and Subject Matter Experts in the areas of Case Management, Utilization Management and ..
Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health episodic and per diem requests. The Medical Director provides medical interpretation and determinations whether ..
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 ..
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 Medical Director - Florida Medicaid in Green Bay Wisconsin Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately ..
Description The Lead Behavioral Health Medical Director oversees the work of 2 Medical Directors who conduct clinical case reviews of the care received by members in an assigned market, member population, ..
Job Information Humana Medicare Appeals and Grievance Medical Director in Green Bay Wisconsin Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare ..
Job Information Humana Senior Provider Contracting Professional - TRICARE Behavioral Health in Green Bay Wisconsin Description Responsibilities The position will provide corporate support to the Director of Provider Contracting and is ..
Job Information Humana Medical Director - National Medicare Team in Green Bay Wisconsin Description The Medical Director relies on medical background and reviews preauthorization requests for services. The Medical Director work ..
Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part C Line of Business. The Medical Director provides medical interpretation and determinations ..
Job Information Humana FP&A Lead, Medicaid Market in Green Bay Wisconsin Description The Financial Planning & Analysis Lead is acritical leadership role with full market financial oversight over the South Carolina ..
Job Information Humana Senior Contract Tools, Education, Processes Professional - ... Bay Wisconsin Description The Senior Contract Tools, Education, Processes Professional builds ... in class knowledge. The Senior Contract Tools,..
Job Information Humana UM Medical Director - Conviva in Green Bay Wisconsin Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately ..
... market contracting teams to influence specialist contract terms that align with Service ... in close coordination with PCP Contract Load, Capitation Rates, Payments, and ... Adjustments teams to ensure..
Description Humana/iCare is seeking a Senior Learning and Development Professional who will develop the training curriculum for the Family Care Partnership (FCP) department and will serve as the interface between the ..
