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Description At Conviva Care Solutions, we want to inspire people to live life their best healthy life. Conviva Care Solutions is a management services organization representing nearly 300 physician practices, 800 ..
Description The Provider Contracting Professional 2 initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Provider Contracting Professional 2 work ..
Job Information Humana Provider Contracting Professional in San Antonio Texas Description The Provider Contracting Professional 2 Behavioral Health Network role; initiates, negotiates, and executes physician, hospital, and/or other provider contracts and ..
Job Information Humana Care Manager, Telephonic Behavioral Health 2 - Remote, US in San Antonio Texas Description Humana Military, a wholly-owned subsidiary of Humana Inc. headquartered in Louisville, KY, partners with ..
Description SeniorBridge/Humana is seeking a Care Management Support Assistant. This professional contributes to the successful administration of home care by providing administrative support in new and existing Home Care markets. This ..
Description The Hospital Contracting Executive initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Hospital Contracting Executive works on problems ..
Job Information Humana Manager, Behavioral Provider Contracting - Remote in San Antonio Texas Description The Manager, of Behavioral Health Provider Contracting communicates contract terms, payment structures, and reimbursement rates to providers ..
Description Humana Military, a wholly-owned subsidiary of Humana Inc. headquartered in Louisville, KY, partners with the Department of Defense to administer the TRICARE health program for military members, retirees and their ..
Description The Associate VP of Payment Innovation supports the creation of new value-based provider relationships with a focus on improving the provider experience and achieving path-to-value goals. The Associate VP of ..
Description Responsibilities This role within the Autism Care Demonstration (ACD) Team, will work closely with Care Management leaders and Subject Matter Experts in the areas of Case Management, Utilization Management and ..
... quality and clinical compliance with contract requirements as outlined in the ... codes. Our Department of Defense Contract requires U.S. citizenship for this ... timely and in accordance with..
Description The Network Operations Coordinator 3 maintains provider relations to support customer service activities through data integrity management and gathering of provider claims data needed for service operations. The Network Operations ..
Job Information Humana Provider Contracting Professional - Behavioral Health in San Antonio Texas Description The Provider Contracting Professional 2 initiates, negotiates, and executes behavioral health physician, hospital, and/or other provider contracts ..
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 Senior Clinical Strategy and Practice Professional builds strategies for development, engagement, best clinical practices and processes for clinical community within the enterprise The Senior Clinical Strategy and Practice Professional ..
Description Responsibilities The Care Management Support Assistant 2- ACD Referral Coordinator-will process referrals from Military Treatment Facilities (MTFs) and civilian providers for the ACD program. The ACD Referral Coordinator performs varied ..
... include national clinical guidelines, Humana contract language, Humana coverage policies and ... whether services provided by other healthcare professionals are in agreement with ... with national guidelines, state mandates,..
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 Responsibilities The Care Manager, Behavioral Health 2 (BCBA) is responsible for the administration and monitoring of the Autism Care Demonstration (ACD) including coordination of services for ABA Therapy, benefits provided ..
... and operations of the TRICARE contract in smaller multi-city geographic areas. ... You will have multiple Humana Contract Offices (HCOs) under your supervision ... for financial performance under the..
... Professional for SC Medicaid communicates contract terms, payment structures, and reimbursement ... and network administration in a healthcare company or healthcare system Medicaid behavioral health contracting ... and communicating..
Description Responsibilities The Consumer Service Operations Professional 2 evaluates claims oversight performance metrics by interfacing with the sub-contractor to gather and track associated reporting. The Consumer Service Operations Professional 2 evaluates ..
