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Description Do you thrive on working on the cutting edge? Working with innovators in the early stages of ideas, products, or platforms? Do you want to transform an industry? Crave new ..
Description Care Management Support Specialists contribute to the administration of care management. The CMSS provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain ..
Description Job Description Summary Care Management Support Specialists contribute to the administration of care management. The CMSS provides non-clinical support to the assessment and evaluation of members' needs and requirements to ..
Job Information Humana Medical Director - Medicare Pharmacy Appeals in Troy Michigan Description The Medical Director relies on clinical background and reviews Medicare drug requests. The Medical director work assignments involve ..
... is looking for an experienced Healthcare Investigator to join its industry ... areas Bachelor's degree or significant healthcare fraud and investigation experience At ... At least 1 year of..
Description The Associate Director, Clinical Pharmacy monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders. Utilizes broad understanding of managed care and PBM knowledge to develop, ..
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 UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on ..
Description The Medical Records Retrieval Representative travels to provider offices within the region and scans medical records into a secure system. The records are reviewed by Humana's Coding staff. Responsibilities The ..
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 ..
Job Information Humana FP&A Lead, Medicaid Market in Troy Michigan Description The Financial Planning & Analysis Lead is acritical leadership role with full market financial oversight over the South Carolina Medicaid ..
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 ..
... Certified Diabetes Care and Education Specialist-Remote-US in Troy Michigan Description The ... Certified Diabetic Care and Education Specialist (CDCES) delivers comprehensive and seamless ... Certified Diabetes Care and Education..
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 ..
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 Humana's Marketing organization is seeking an experienced Market Research Lead to join the Market Research Department working remote anywhere in the U.S. This is a newly added role that will ..
Description The Supervisor, Pre-Authorization Nursing reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The Supervisor, Pre-Authorization ..
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 ..
Description iCare is seeking an Enrollment Specialist who will support the iCare enrollment processing duties for all lines of business including Medicare, Medicaid, Family Care Partnership (FCP) and BadgerCare Plus. Responsibilities ..
Job Information Humana Senior Provider Contracting Professional - TRICARE Behavioral Health in Troy Michigan Description Responsibilities The position will provide corporate support to the Director of Provider Contracting and is responsible ..
