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Description The Care Manager, Telephonic Nurse 2 , 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 ..
... facility The Supervisor, Care Management Support will lead a team of ... a team of 16-22 care support professionals and contributes to administration ... of care management. Provides non-clinical..
Description Care Management Support Specialists contribute to the administration ... management. The CMSS provides non-clinical support to the assessment and evaluation ... and wellbeing of members. The Support Specialist performs..
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 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 Supervisor, 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 Supervisor, Compliance ..
Description Risk Adjustment Coders are responsible for reviewing medical records, completing multiple audits, and special projects. Associates in this role work collaboratively with other departments. Responsibilities The Risk Adjustment Coder ensures ..
Job Information Humana Pre- Authorization Nursing Supervisor-- REMOTE/WORK AT HOME (Anywhere in the US) in Charleston West Virginia Description The Supervisor, Pre-Authorization Nursing will be managing the team that reviews prior ..
... The Senior Professional provides internal support to Provider Network by following ... Qualifications Bachelor's Degree in Business, Healthcare Administration, Mathematics and/or related field ... implementation technical experience Medicaid experience..
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 ..
Job Information Humana Home Health LPN/LVN in South Charleston West Virginia Description Responsibilities The Home Health Nursing, LPN/LVN enables patients to stay in their homes by providing health and personal services; ..
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 Description Summary Care Management Support Specialists contribute to the administration ... management. The CMSS provides non-clinical support to the assessment and evaluation ... and wellbeing of members. The..
Description The Lead Behavioral Health Medical Director oversees the work of 2 Medical Directors who conduct clinical case reviews of the care received by members in an assigned market, member population, ..
... looking for an experienced Senior Healthcare Investigator to join its industry ... Assembles evidence and documentation to support successful adjudication, where appropriate. Conducts ... Qualifications Bachelor's degree or significant..
... is looking for an experienced Healthcare Investigator to join its industry ... Assembles evidence and documentation to support successful adjudication, where appropriate. Conducts ... areas Bachelor's degree or significant..
Description The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments ..
Description The Supervisor, Care Management Support contributes to administration of care ... of care management. Provides non-clinical support to the assessment and evaluation ... members. The Supervisor, Care Management Support..
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 ..
Genesis is one of the nations' leading provider of healthcare services from short-term to long-term care and a wide variety of living options and professional clinical services. We are changing how ..
... Certified Diabetes Care and Education Specialist-Remote-US in Charleston West Virginia Description ... Certified Diabetic Care and Education Specialist (CDCES) delivers comprehensive and seamless ... Certified Diabetes Care and Education..
