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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 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 appeals for Medicare Part C Line of Business. The Medical Director provides medical interpretation and determinations ..
Job Information Humana UM Medical Director - Conviva in Newport Rhode Island Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately ..
Job Information Humana FP&A Lead, Medicaid Market in Newport Rhode Island Description The Financial Planning & Analysis Lead is acritical leadership role with full market financial oversight over the South Carolina ..
Job Information Humana Medical Director - Florida Medicaid in Newport Rhode Island Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately ..
Healthy Transitions Supported Employment/Education Specialist (Full Time) Location: Woonsocket, RI All staff must be vaccinated for COVID-19 prior to starting work, unless a certified medical exemption accommodation is granted. Proof of ..
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 Senior Contract Tools, Education, Processes Professional - ... Rhode Island Description The Senior Contract Tools, Education, Processes Professional builds ... in class knowledge. The Senior Contract Tools,..
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 Medical Director - National Medicare Team in Newport Rhode Island Description The Medical Director relies on medical background and reviews preauthorization requests for services. The Medical Director work ..
... 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 Medicare Appeals and Grievance Medical Director in Newport Rhode Island Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare ..
