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Description Healthcare isn't just about health anymore. ... of our patients, and the healthcare industry as a whole. As ... a whole. As a senior-focused healthcare provider, and subsidiary of..
Description The Care Manager, Telephonic Nurse 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and ..
... Certified Diabetes Care and Education Specialist-Remote-US in Lancaster South Carolina Description ... Certified Diabetic Care and Education Specialist (CDCES) delivers comprehensive and seamless ... Certified Diabetes Care and Education..
Description Responsibilities As part of the Service Fund Specialty Load Team, the Senior Provider Installation Professional will work directly with our national and market contracting teams to influence specialist contract terms ..
Description The Director, Pharmacy Clinical Formulary and Medical Drug Strategies oversees and drives the pharmacy and medical drug formulary strategies across all lines of business (Medicare, Commercial, Medicaid). This position will ..
... of coding practices and clinical documentation, grievance and appeals processes, and ... whether services provided by other healthcare professionals are in agreement with ... Delivery Systems, health insurance, other..
Job Information Humana Senior Clinical Pharmacy Advisor, Clinical Program Innovation in Lancaster South Carolina Description The Senior Pharmacy Clinical Advisor will be part of an interactive team with broad exposure and ..
Job Information Humana Clinical Formulary Strategy Pharmacist - Work At Home in Lancaster South Carolina Description Responsibilities The Clinical Formulary Strategy Pharmacist monitors drug development pipeline, and medical literature, while providing ..
Description The Clinical Pharmacy Lead for Pharmacy trend will be a part of an interactive team with broad exposure and scope within Humana. Humana is seeking a positive and proactive individual ..
... is looking for an experienced Healthcare Investigator to join its industry ... enforcement authorities. Assembles evidence and documentation to support successful adjudication, where ... areas Bachelor's degree or significant..
Job Information Humana Pre- Authorization Nursing Supervisor-- REMOTE/WORK AT HOME (Anywhere in the US) in Lancaster South Carolina Description The Supervisor, Pre-Authorization Nursing will be managing the team that reviews prior ..
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 ..
Job Information Humana Medical Director - Medicare Pharmacy Appeals in Lancaster South Carolina Description The Medical Director relies on clinical background and reviews Medicare drug requests. The Medical director work assignments ..
Job Information Humana Risk Adjustment Representative 3- Scheduler in Lancaster South Carolina Description The Risk Adjustment Representative 3 (Scheduler) conducts quality assurance review of medical records and ICD-9/10 diagnosis codes that ..
Job Information Humana Medical Director - S. Florida in Lancaster South Carolina Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately ..
... looking for an experienced Senior Healthcare Investigator to join its industry ... enforcement authorities. Assembles evidence and documentation to support successful adjudication, where ... Qualifications Bachelor's degree or significant..
Job Information Humana Medicare Appeals and Grievance Medical Director in Lancaster South Carolina Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare ..
Description Upstate South Carolina (Oconee County, Anderson, Greenville County) and Northeast GA (Madison, Elbert, Banks, Franklin County) The Medical Records Retrieval Specialist/ Risk Adjustment Representative 2 conducts quality assurance review of ..
Description The Supervisor, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Supervisor, Compliance ..
... whether services provided by other healthcare professionals are in agreement with ... whether services provided by other healthcare professionals are in agreement with ... Delivery Systems, health insurance, other..
Job Information Humana FP&A Lead, Medicaid Market in Lancaster South Carolina Description The Financial Planning & Analysis Lead is acritical leadership role with full market financial oversight over the South Carolina ..
Description The Care Manager, Telephonic Nurse 2 employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder ..
... of services provided by other healthcare professionals in compliance with review ... whether services provided by other healthcare professionals are in agreement with ... Delivery Systems, health insurance, other..