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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 ..
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Job Information Humana Clinical Recruiter 2 - VSP in San Juan Puerto Rico Description The Clinical Recruiter 2 interviews prospective employees for hourly and salaried positions. Assists with Pharmacy recruiting from ..
Job Information Humana Clinical Analytics and Trend Program Manager ... Juan Puerto Rico Description The Clinical Strategy and Practice Lead builds ... strategies for development, engagement, best clinical practices and..
Description The Medical Coding Coordinator 2 extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Medical ..
... are interested in using their clinical and analytical skills to help ... the healthcare industry. As a clinical informaticist at Humana you will ... departments. Responsibilities Apply understanding of..
Description Humana's Enterprise Clinical Management team needs your clinical, business and analytics acumen to ... healthcare challenges of today. The Clinical Analytics and Trend team uses ... techniques, data analysis,..
... Quality Medical Director will manage clinical vendor quality outcomes for Humana ... vendor quality outcomes for Humana Clinical Operations Team. Responsibilities A full ... time Medical Director to manage..
Description The Clinical Recruiter recruits and interviews prospective employees for hourly and salaried positions for our Care Delivery Organization. Humana is seeking a recruiter who is a self-starter, able to work ..
... to grow, the National Medicaid Clinical Operations team is expanding our ... services organization to enhance the clinical delivery process. The Associate Director, ... and services to support 24/7..
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 ..
... 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..
... matter most to consumers, our clinical quality and brand strategy can ... Advancement Advisor will support quality clinical strategy for Humana's Enterprise Clinical Operating Model (ECOM). The Advisor .....
... (EFMP), auditing for quality and clinical compliance, and case management. Serve ... documentation. Complete required audits of clinical records. Assist in entry and ... Ensure audits are entered for..
... team that helps translate the clinical into financial to ensure Humana ... optimization and specialty drug focused clinical programs. As specialty drugs continue ... the development and execution of..
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 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 Humana's Claims Cost Management (CCM) organization is seeking a Manager, Fraud & Waste to join the Provider Payment Integrity-Clinical Audit team working remote anywhere in the US. As the Fraud ..
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 ..
... unrestricted license to include: Licensed Clinical Social Worker (LCSW), Licensed Masters ... Licensed Masters Social Worker (LMSW-ACP), Clinical Psychologist with; Clinical experience in: pediatrics, behavioral health, ... of 1..
Description The Senior Provider Engagement, Clinical Professional develops and grows positive, ... plan. The Senior Provider Engagement, Clinical Professional work assignments involve moderately ... Responsibilities The Senior Provider Engagement, Clinical..
Description The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within ..
