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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 UM Medical Director - Conviva in Pittsburgh Pennsylvania Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..
Job Information Humana Medicare Appeals and Grievance Medical Director in Pittsburgh Pennsylvania Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part ..
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 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 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 ..
$2,500 sign-on bonus We have an immediate opportunity for Community Liaisons. General Summary: The Community Liaison performs daily marketing and community education calls including face to face contact, telemarketing and written ..
We have an immediate opportunity for Community Liaisons. General Summary: The Community Liaison performs daily marketing and community education calls including face to face contact, telemarketing and written correspondence. Develops and ..
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 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 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 ..
... 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 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 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 ..
We have an immediate opportunity for an Director of Admissions General Summary: The Director of Admissions is responsible for the hospital’s overall admission process and staff. The Director of Admissions is ..
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 ..
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 ..
We have an immediate opportunity for Admissions Representatives General Summary: The Admissions Representative serves as the coordination point for referring facilities, physicians, payors and families by coordinating all aspects of referral/admission ..
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 ..
