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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,..
n n Helpn n Requirementsn Conditions of Employmentn n n n ntU.S. Citizenship; non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA ..
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 ..
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 ..
This position is eligible for the Education Debt Reduction Program (EDRP), a student loan payment reimbursement program. You must meet specific individual eligibility requirements in accordance with VHA policy and submit ..
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 ..
Interim Physicians has a locum tenens opportunity for an Internal Medicine physician in South Dakota.nPosition Detailsnn Census: 8-12 patient per dayn Schedule: Monday-Friday, 8a - 4:30pn Outpatient facilityu00a0n No procedures requirednnAssignment ..
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 ..
... 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..
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 ..
Job Information Humana Strategy Advisor, Healthcare Strategy in Aberdeen South Dakota ... Dakota Description The Strategy Advisory, Healthcare Strategy provides data-based strategic direction ... Responsibilities Humana: A Fortune 100 Healthcare..
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 ..
Job Information Humana Medical Director - Medicare Pharmacy Appeals in Aberdeen South Dakota Description The Medical Director relies on clinical background and reviews Medicare drug requests. The Medical director work assignments ..
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 ..
Job Information Humana Medicare Appeals and Grievance Medical Director in Aberdeen South Dakota 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, ..
