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Description CenterWell Senior Primary Care, a subsidiary of Humana Inc., is the new brand for a primary care medical group practice with centers open or opening in Florida, Georgia, Kansas, Louisiana, ..
... 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 ..
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 ..
... 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 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 ..
... 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..
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 ..
Job Information Humana Senior Provider Contracting Professional - TRICARE Behavioral Health in Troy Michigan Description Responsibilities The position will provide corporate support to the Director of Provider Contracting and is responsible ..
... offers many benefits to help support the well-being of our military ... Responsibilities As a Resolution Management Specialist, you'll ensure client, provider, external ... the client. Strong Knowledge of..
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 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 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 Humana Pre- Authorization Nursing Supervisor-- REMOTE/WORK AT HOME (Anywhere in the US) in Troy Michigan Description The Supervisor, Pre-Authorization Nursing will be managing the team that reviews prior authorization ..
... Certified Diabetes Care and Education Specialist-Remote-US in Troy Michigan Description The ... Certified Diabetic Care and Education Specialist (CDCES) delivers comprehensive and seamless ... Certified Diabetes Care and Education..
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 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 ..
... 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 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 ..
