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Description The Care Manager, Telephonic Behavioral Health 2 , ... wellbeing of members. The Care Manager, Telephonic Behavioral Health 2 work ... of action. Responsibilities The Care Manager, Telephonic Behavioral..
Description The Care Manager, Telephonic Nurse 2 , in ... wellbeing of members. The Care Manager, Telephonic Nurse 2 work assignments ... action. Responsibilities The RN Care Manager, Telephonic Nurse..
Job Information Humana Technical Product Manager - Remote in Charleston West ... Senior Product Management Professional/Technical Product Manager (TPM) must be able to ... product backlog. The technical product manager..
Description The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within ..
... Humana Nationwide Medicaid Behavioral Health Quality Lead in Charleston West Virginia ... Virginia Description The Behavioral Health Quality Lead will report directly to ... directly to the National Medicaid..
Description The Senior Quality Improvement Professional will focus organizational ... (BH)/Substance Use Disorder (SUD) clinical quality performance measures to achieve optimal ... to achieve optimal performance and quality for the..
Job Information Humana Senior Innovation Portfolio Strategy Professional in Charleston West Virginia Description The Humana Healthy Horizons Strategic Solutions team's purpose is to accelerate the ideation and development of transformational initiatives ..
Job Information Humana Manager, Care Management Social Services-WAH Nationwide ... Description Job Description Summary The Manager, Care Management leads teams of ... multi-disciplinary care management team. The Manager, Care Management..
Description The Senior Pre-Authorization Nurse reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. Makes decisions on ..
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 ..
Job Information Humana Senior Care Manager, Behavioral Health (BCBA) in Charleston ... Description Responsibilities The Senior Care Manager, Behavioral Health (BCBA) is responsible ... Member Plan (EFMP), auditing for quality..
... of services provided by other healthcare professionals in compliance with review ... issues regarding technical approach for project components, and work is performed ... whether services provided by other..
Description The Manager, 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 Manager, Compliance ..
Description The Humana Healthy Horizons Strategic Solutions team's purpose is to accelerate the ideation and development of transformational initiatives that maximize customer value to create a differentiated value proposition for Humana ..
Job Information Humana Quality Improvement Program Lead (National Medicaid ... Improvement Program Lead (National Medicaid Quality) in Charleston West Virginia Description ... Healthy Horizons is seeking a Quality Improvement Program..
Description Responsibilities The Care Manager, Behavioral Health 2 (BCBA) is responsible for the administration and monitoring of the Autism Care Demonstration (ACD) including coordination of services for ABA Therapy, benefits provided ..
... Information Humana Senior Technical Product Manager in Charleston West Virginia Description ... Description The Senior Technical Product Manager (TPM) must be able to ... dependencies. The Senior Technical Product..
Description The Manager, Risk Adjustment oversees coding educators and quality assurance audits of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS). ..
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 ..
