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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 ..
The Autism Resources Specialist (K-5) provides support in diagnostic assessments; identifies needs and assists in the program planning for students with Autism Spectrum Disorder (ASD) and works to build sustainable practices ..
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 ..
... Position Summary The HIM Coding Specialist will handle medical coding and ... outpatient procedures consistent with client contract and documentation in the medical ... problem list consistent with client..
Job Information Humana Medicare Appeals and Grievance Medical Director in Montpelier Vermont Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part ..
Job Information Humana Senior Contract Tools, Education, Processes Professional - ... Montpelier Vermont 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 Montpelier Vermont Description The Medical Director relies on medical background and reviews preauthorization requests for services. The Medical Director work assignments ..
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 ..
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 ..
... oversees the implementation of student healthcare plans, health management protocols, and ... includes planning and implementing Individualized Healthcare Plans (IHP) and services for ... recommendations. Participates as the health..
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 Montpelier Vermont Description The Financial Planning & Analysis Lead is acritical leadership role with full market financial oversight over the South Carolina Medicaid ..
Job Information Humana UM Medical Director - Conviva in Montpelier Vermont Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..
... 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 - Florida Medicaid in Montpelier Vermont Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..
