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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 ..
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 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, ..
... analysis of data, and strategic contract performance improvement initiatives. Act as ... of specialty network contracts. Analyze contract performance and provide evaluation on ... existing contracts. Build and maintain..
Description Responsibilities Humana's Primary Care Organization is one of the largest and fastest growing value-based, senior primary care groups in the country, providing care to over 200,000 seniors across 175 sites ..
... 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..
Job Information Humana FP&A Lead, Medicaid Market in Las Vegas Nevada Description The Financial Planning & Analysis Lead is acritical leadership role with full market financial oversight over the South Carolina ..
Job Information Humana Medicare Appeals and Grievance Medical Director in Las Vegas Nevada Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare ..
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 ..
Description The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations. The Behavioral Health Medical Director work assignments involve moderately complex to complex issues where the analysis of ..
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 Medical Director - Florida Medicaid in Las Vegas Nevada Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately ..
Admin / Clerical (188) Advanced Practice Registered Nurses / Physician Assistants (339) Allied Health (3185) Executive (81) Operations (252) Physicians/Surgeons (1354) Quality/Risk Management (19) Type Contract (1) Fellowship (0) Full Time ..
Job Information Humana Senior Contract Tools, Education, Processes Professional - ... Vegas Nevada Description The Senior Contract Tools, Education, Processes Professional builds ... in class knowledge. The Senior Contract Tools,..
Job Information Humana Medical Director - National Medicare Team in Las Vegas Nevada Description The Medical Director relies on medical background and reviews preauthorization requests for services. The Medical Director work ..
Admin / Clerical (0) Advanced Practice Registered Nurses / Physician Assistants (3) Allied Health (0) Executive (48) General Nursing (0) Operations (0) Physicians/Surgeons (4691) Quality/Risk Management (0) Type Contract (3) Fellowship ..
