Specialist Jobs in Charleston

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 ..

Description Care Management Support Specialists contribute to the administration of care management. The CMSS provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain ..

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 Job Description Summary Care Management Support Specialists contribute to the administration of care management. The CMSS provides non-clinical support to the assessment and evaluation of members' needs and requirements to ..

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, ..

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 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, 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 ..

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 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 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 ..

Award-winning multiple-location private practice looking to bring a full time Medical Optometrist to their accomplished team of MDs/ODs. This is a physician friendly patient care focused independant private practice with a ..

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 ..

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 ..

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; ..

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 ..

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 ..

Hospital  is seeking a BC/BE Urologist to join a hospital employed practice. n nThe ideal candidate will perform the full spectrum of urologic procedures. There is an opportunity to do advanced ..

Job Information Humana Fraud and Waste Investigator - Work At Home (Anywhere in the US) in Charleston West Virginia Description Humana is looking for an experienced Healthcare Investigator to join its ..

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 Care Manager, Telephonic Nurse 2 Certified Diabetes Care and Education Specialist-Remote-US in Charleston West Virginia Description The Certified Diabetic Care and Education Specialist (CDCES) delivers comprehensive and seamless ..

Job Information Humana Senior Fraud and Waste Investigator-- REMOTE/WORK AT HOME in Charleston West Virginia Description Humana is looking for an experienced Senior Healthcare Investigator to join its industry leading Special ..