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... Humana Senior Process Improvement Professional (HealthCare, Provider Value exp.) Work at ... Medicaid business partners, including: Contracting, Credentialing, Referral/Authorizations, Claims, Grievance and Appeals, ... a Bachelor's degree in Business,..
Description The Senior Clinical Fraud and Waste Professional performs analysis of clinical investigations of allegations of fraudulent and abusive practices. The Senior Clinical Fraud and Waste Professional work assignments involve moderately ..
Job Information Humana Supervisor, Credentialing in Lancaster South Carolina Description ... Carolina Description Responsibilities The Supervisor, Credentialing Operations is responsible for supervising ... years of experience in provider credentialing and/or..
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 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 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's primary responsibility is the review of medical authorizations or claims to determine the medical necessity of a given service or level of care. The Medical Director's work ..
Pediatric Hospitalist US-SC-Fort Mill Job ID: 2022-36142 Type: Physician - Pediatrician/Pediatric Hospitalist # of Openings: 1 Category: Physician SCPDFM Overview Great opportunity to join a dynamic group in desirable, Charlotte/Ft. Mill ..
Description The Senior Professional, Medicaid Network Strategy will be accountable for supporting the development of Humana Healthy Horizon's (Medicaid) network and provider strategy for its growth markets. This strategist will provide ..
... of services provided by other healthcare professionals in compliance with review ... whether services provided by other healthcare professionals are in agreement with ... departments, Humana colleagues and the..
Job Information Humana Strategy Advisor, Healthcare Strategy in Lancaster South Carolina ... Carolina Description The Strategy Advisory, Healthcare Strategy provides data-based strategic direction ... Responsibilities Humana: A Fortune 100 Healthcare..
Description Join Humana's Talent Acquisition organization to support our growing Healthcare Services division! The Senior Physician Recruiter recruits qualified physicians for medical staff and assists in development of strategic physician recruitment ..
Job Information Humana Manager, Credentialing in Lancaster South Carolina Description ... a team of certification and credentialing professionals that to ensure required ... contract requirements. Work collaboratively with credentialing leaders..
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 ..
