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Job Summary The Healthcare Quality Assurance (QA) Validation Specialist is responsible for assisting with ... in UPS Supply Chain Solutions healthcare computer systems. He/She assists QA ... validation projects that..
Job Information Humana Medicare Appeals and Grievance Medical Director in Atlanta Georgia Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part ..
Job Information Humana Physician - CenterWell - Grove Park in Atlanta Georgia Description Humana's Primary Care Organization is one of the largest and fastest growing value-based care, senior-focused primary care providers ..
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, ..
Job Information Humana Home Health LPN/LVN in Atlanta Georgia Description Responsibilities The Home Health Nursing, LPN/LVN enables patients to stay in their homes by providing health and personal services; supporting patients ..
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 Records Retrieval Specialist/ Risk Adjustment Representative 2 travels to provider offices within the region and scans medical records into a secure system. The records are reviewed by Humana's ..
Job Information Centerwell Home Health Admissions RN in Stockbridge Georgia The Clinical Assessment Advisor directly completes and oversees development/ of the plan of treatment as approved by physician, performs ongoing evaluation ..
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 Senior Provider Contracting Professional - TRICARE Behavioral Health in Atlanta Georgia Description Responsibilities The position will provide corporate support to the Director of Provider Contracting and is responsible ..
Description The Supervisor, Care Management Support contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness ..
... 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 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 ..
Job Information Centerwell Physician - CenterWell - Morrow, GA in Morrow Georgia Description Humana's Primary Care Organization is one of the largest and fastest growing value-based care, senior-focused primary care providers ..
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 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 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 ..
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 ..
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 ..
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 ..
