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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 Responsibilities As part of the Service Fund Specialty Load Team, the Senior Provider Installation Professional will work directly with our national and market contracting teams to influence specialist contract terms ..
... 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..
Job ID 21000L00Available Openings 1PURPOSE AND SCOPE: Functions as the hemodialysis team leader in the provision of chronic hemodialysis care and treatment. Provides day to day direction and supervision to assigned ..
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 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 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 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 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 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 ..
United Therapeutics is a vaccinated work environment where all employees are expected to be vaccinated against COVID-19 and provide proof of vaccination. We will provide any accommodations as required by law.The ..
... medical literature, while providing clinical support for internal stakeholders. Utilizes broad ... senior leadership on key metrics Support clinical research integration activities with ... other leaders throughout HPS to..
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 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 ..
BAYADA Home Health is looking for compassionate and dedicated Registered Nurses (RNs) to join our team in Windham County, VT . This office services our adult and geriatric clients on a ..
Job Location Merrimack, NH - 3603 - Merrimack, NH Position Type Full Time Salary Range $37,000.00 - $38,000.00 Salary/year There's a spot on our team waiting for you! Become a Team ..
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 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 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 ..
