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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 Health Information Management Professional ensures data integrity for claims errors. The Health Information Management Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate ..
Description The DRG Validation Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM and PCS) to patient records. The Medical ..
Description Are you passionate about contributing to the well-being of the Medicare population? Are you looking for a role that will let your creative ideas, relationship management and sales ability shine? ..
Description The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Medical Coding ..
Description The Senior Pharmacy Clinical Advisor is an integral part of the Pharmacy Stars team which is accountable for Humana's medication related Star measure performance. The Senior Pharmacy Clinical Advisor develops ..
Description Humana is a $90 billion (Fortune 40) market leader in integrated healthcare with a clearly defined purpose to help people achieve lifelong well-being. As a company focused on the health ..
Job Information Humana Care Management Support Specialist in Honolulu Hawaii Description A day in the life of a CMSS would consist of being aligned to one of over 6 different tasks ..
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 ..
Description The Provider Contracting Professional initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Provider Contracting Professional work assignments are ..
Description The Behavioral Health Care Manager, Telephonic Nurse, 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 ..
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 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 Oncology Staff Utilization Management Pharmacist is a clinical pharmacist who completes medical necessity and comprehensive medication reviews for prescriptions requiring pre-authorization, with a focus on oncology requests. The Oncology ..
Job Information Humana Telephonic Behavioral Health Care Manager in Honolulu Hawaii Description The Behavioral Health Care Manager, in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or ..
Description The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. Responsibilities ..
Job Information Humana Senior Corporate Strategy Analyst in Honolulu Hawaii Description Humana's Corporate Stragtegy team is a high-performing organization that works closely with Humana's senior leaders to help chart the course ..
Description Humana Medicaid is growing and you have the unique opportunity to grow with us! Join our team and propel Humana forward to solve the technology challenges of tomorrow. You'll collaborate ..
Description Humana is seeking a Physician Strategy Sr. Professional to join our growing team. The Physician Strategy professional will be responsible for setting and implementing strategy for internal and external physician ..
Description The Data and Reporting Professional II generates ad hoc reports and regular datasets or report information for end-users using system tools and database or data warehouse queries and scripts. The ..
Job Information Humana Corporate Strategy Consultant in Honolulu Hawaii Description Humana's Corporate Stragtegy team is a high-performing organization that works closely with Humana's senior leaders to help chart the course for ..
Description The mission of the Physician Performance Insights team is to empower Humana members to make informed healthcare decisions. Our key goal is to ensure transparency and help our members obtain ..
Description The Care Management Support Assistant provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and ..
