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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 ..
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Description The Senior Market Development Professional provides support to assigned health ... submissions. The Senior Market Development Professional work assignments involve moderately complex ... The Clinical Senior Market Development Professional..
Description The Director, Provider Reimbursement is responsible for the leadership, strategy development and execution of Humana Military's provider reimbursement methodologies. This leader is responsible for timely and accurate implementation of Government ..
... multiple managers or highly specialized professional associates. The role requires experience ... processing clinical authorizations and clinical claims reviews Assure compliance with state ... Utilization Management and Case Management..
... Responsibilities The Consumer Service Operations Professional 2 evaluates claims oversight performance metrics by interfacing ... reporting. The Consumer Service Operations Professional 2 evaluates metrics for early identification ... of..
... The Senior Medical/Financial Risk Evaluation Professional is responsible for supporting the ... The Senior Medical/Financial Risk Evaluation Professional work assignments involve moderately complex ... The Senior Medical/Financial Risk Evaluation..
Description The Medical Coding Coordinator 2 extracts clinical information from a ... records. The Medical Coding Coordinator 2 performs varied activities and moderately ... Responsibilities The Medical Coding Coordinator 2..
... to enhance the clinical delivery process. The Associate Director, Compliance Nursing ... multiple managers or highly specialized professional associates. The Associate Director, Compliance ... Responsibilities include: Leads Medicaid operational..
... and delivering on initiatives and process capabilities that enable improved effectiveness, ... identify, advise, lead and facilitate process improvement opportunities. KEY ACCOUNTABILITIES Process Improvement and Project Management Contributes .....
... to enhance the clinical delivery process. The Associate Director, Utilization Management ... multiple managers or highly specialized professional associates. Detailed Responsibilities include: Leads ... Leads National Medicaid Utilization Management..
... with contract and complex ACD policy requirements as defined by the ... 4. Responsibilities The Senior Compliance Professional responsibilities include analyzing data, reporting ... Demonstrates understanding of the ACD..
... Care Manager, Telephonic Behavioral Health 2 , in a telephonic environment, ... Care Manager, Telephonic Behavioral Health 2 work assignments are varied and ... Care Manager, Telephonic Behavioral Health..
Description The Pharmacy Claims Lead operationalizes and monitors Coordination ... Cultural Competency Enable personal & professional growth Develop analytics and reporting ... business Actively identifies and owns process improvements and..
Description The Senior Claims Process & Policy Professional processes new insurance policies, modifications ... modifications to existing policies, and claims forms. The Senior Claims Process & Policy Professional work assignments..
Description Humana's Claims Cost Management (CCM) organization is ... support our efforts for ensuring claims payment accuracy, so that our ... to day work of reviewing claims payments for clinical/coding..
