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Description The Associate Director, Care Management leads teams of nurses and behavior health professionals responsible for care management. The Associate Director, Care Management requires a solid understanding of how organization capabilities ..
Description The Manager, Care Management leads teams of nurses and behavior health professionals responsible for care management. The Manager, Care Management works within specific guidelines and procedures; applies advanced technical knowledge ..
Company Name: Kroger Specialty Pharmacy Position Type: Employee FLSA Status: POSITION SUMMARY Responsible for managing evaluation, implementation, and monitoring of Health and Wellness quality improvement projects; analyzing and summarizing quality data ..
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 ..
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 ..
Job Information Humana Medical Director - Medicare Pharmacy Appeals in San Juan Puerto Rico Description The Medical Director relies on clinical background and reviews Medicare drug requests. The Medical director work ..
Job Information Humana Supervisor, Care Management Support/FULLY BILLINGUAL (Healthcare/ Analytical Support Mgmt.) San Juan, PR in San Juan Puerto Rico Description The Supervisor, Care Management Support contributes to administration of care ..
Job Information Humana UM Medical Director - Conviva in San Juan Puerto Rico Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve ..
Description The Provider Contracting Executive initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements. The Provider Contracting Executive engages in strategic negotiation and relationship-building with a variety of ..
Job Information Humana Senior Fraud and Waste Investigator-- REMOTE/WORK AT HOME in San Juan Puerto Rico Description Humana is looking for an experienced Senior Healthcare Investigator to join its industry leading ..
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 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 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 Pre- Authorization Nursing Supervisor-- REMOTE/WORK AT HOME (Anywhere in the US) in San Juan Puerto Rico Description The Supervisor, Pre-Authorization Nursing will be managing the team that reviews ..
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 ..
Job Information Humana Medicare Appeals and Grievance Medical Director in San Juan Puerto Rico Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for ..
Job Information Humana FP&A Lead, Medicaid Market in San Juan Puerto Rico Description The Financial Planning & Analysis Lead is acritical leadership role with full market financial oversight over the South ..
Description Humana is seeking an experienced management professional to lead an interactive team with broad exposure and scope within Humana. This position will work and collaborate with leaders across the Humana ..
Job Information Humana Fraud and Waste Investigator - Work At Home (Anywhere in the US) in San Juan Puerto Rico Description Humana is looking for an experienced Healthcare Investigator to join ..
