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Description The Lead, Software Quality & Testing ensures that software products meet business standards, functional and non-functional requirements. The Lead, Software Quality & Testing works on problems of diverse scope and ..
Description The Quality Assurance, Clinical Professional 2 consults and collaborates ... and quality. The Quality Assurance, Clinical Professional 2 work assignments are ... you should strongly consider the Clinical Quality..
... part of Humana within the Clinical IT area. We are looking ... test data management program. The Clinical Test Data Quality Lead will ... responsible for modeling the multiple..
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 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 Staff Utilization Management Pharmacist is a clinical pharmacist who completes medical necessity and comprehensive medication reviews for prescriptions requiring pre-authorization. The Staff Utilization Management Pharmacist work assignments involve moderately ..
Description Humana's recently created Clinical Resource Team is looking to ... Do you have a solid clinical background in acute care? Well, ... Auditor opportunity with Humana. Performs clinical audit/validation..
Description The Risk Adjustment Coder ensures coding is accurate and properly supported by clinical documentation within the health record. Follows state and federal regulations as well as internal policies and guidelines ..
Description The UM Administration Coordinator 1 contributes to administration of utilization management. The UM Administration Coordinator 1 performs basic administrative/clerical/operational/customer support/computational tasks. Typically works on routine and patterned assignments. Responsibilities The ..
Description The UM Administration Coordinator 1 contributes to administration of utilization management. The UM Administration Coordinator 1 performs basic administrative/clerical/operational/customer support/computational tasks. Typically works on routine and patterned assignments. Responsibilities Job ..
Description The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. The ..
Description The Manager, Credentialing obtains and reviews documentation to determine status in a health plan. The Manager, Credentialing works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately ..
... resources which may include national clinical guidelines, Humana contract language, Humana ... coverage policies and determinations, MCG, clinical reference materials, internal teaching conferences, ... computer-based review of moderately complex..
Description The Credentialing Representative 2 obtains and reviews documentation to determine status in a health plan. The Credentialing Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. ..
Description The Medical Coding Auditor Supervisor handles a combination of tasks, including extracting clinical information from a variety of medical records and assigning appropriate procedural terminology and medical codes (e.g., ICD-10-CM, ..
Description The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if an a grievance, appeal or further request ..
Description Lead, Technology Solutions (Clinical UM) The Lead, Technology Solutions ... strategic technology partner for Humana's clinical business areas including Clinical Operations (focusing on Utilization management), ... Operations (focusing on..
... resources, which may include national clinical guidelines, CMS policies and determinations, ... guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, ... of moderately complex to complex..
