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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 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 Senior Contract Tools, Education, Processes Professional - ... South Carolina Description The Senior Contract Tools, Education, Processes Professional builds ... in class knowledge. The Senior Contract Tools,..
Job Information Humana Medicare Appeals and Grievance Medical Director in Lancaster South Carolina Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare ..
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, ..
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 UM Medical Director - Conviva in Lancaster South Carolina Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately ..
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 ..
... 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..
Job Information Humana FP&A Lead, Medicaid Market in Lancaster South Carolina Description The Financial Planning & Analysis Lead is acritical leadership role with full market financial oversight over the South Carolina ..
Job Information Humana Medical Director - National Medicare Team in Lancaster South Carolina Description The Medical Director relies on medical background and reviews preauthorization requests for services. The Medical Director work ..
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..
Description Provides executive leadership to Humana. 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 ..
Job Information Humana Medical Director - Florida Medicaid in Lancaster South Carolina Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately ..
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 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 ..
