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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..
Coding Specialist We have exciting employment opportunities ... Position Summary The HIM Coding Specialist will handle medical coding and ... outpatient procedures consistent with client contract and documentation in the..
We have an immediate opportunity for Admissions Coordinator The Admissions Coordinator serves as the point of contact for the clinical assessment process. Assesses by phone the needs of patient, collecting data ..
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 ..
... 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 Medical Director - National Medicare Team in Pittsburgh Pennsylvania Description The Medical Director relies on medical background and reviews preauthorization requests for services. The Medical Director work assignments ..
Job Information Humana Senior Contract Tools, Education, Processes Professional - ... Pittsburgh Pennsylvania Description The Senior Contract Tools, Education, Processes Professional builds ... in class knowledge. The Senior Contract Tools,..
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 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 ..
Job Information Humana FP&A Lead, Medicaid Market in Pittsburgh Pennsylvania Description The Financial Planning & Analysis Lead is acritical leadership role with full market financial oversight over the South Carolina Medicaid ..
Job Information Humana Pharmacy Technician Networks Specialist, Remote PA or NJ in Pittsburgh Pennsylvania Description The Provider Contracting Administration Coordinator 2 supports the administration of the contracting function. The Provider Contracting ..
Job Information Humana UM Medical Director - Conviva in Pittsburgh Pennsylvania Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..
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 ..
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, ..
Job Information Humana Medicare Appeals and Grievance Medical Director in Pittsburgh Pennsylvania Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part ..
Job Information Humana Medical Director - Florida Medicaid in Pittsburgh Pennsylvania Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..
