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Job Information Humana Manager, Behavioral Provider Contracting - Remote in Aberdeen South Dakota Description The Manager, of Behavioral Health Provider Contracting communicates contract terms, payment structures, and reimbursement rates to providers ..
Job Information Humana Associate Director, National Contracting Alabama in Aberdeen South Dakota Description The Associate Director, Provider Contracting initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for ..
Description The Director, Provider Contracting- Behavioral Health initiates, negotiates, and executes physician, hospital, and/or other provider behavioral health contracts for an organization that provides health insurance. Requires an in-depth understanding of ..
Description The Lead, Technology and Cybersecurity Exams, Audits, and Client Inquiries is responsible for management of formal and informal technology reviews across IT. This involves a rigorous process which shapes and ..
Description The Behavioral Health Medical Director makes determinations regarding prior authorization and retrospective reviews for inpatient and outpatient services to ensure that members receive clinically appropriate and medically necessary services. All ..
Description The Director, Provider Contracting- Behavioral Health Medicaid initiates, negotiates, and executes physician, hospital, and/or other provider behavioral health contracts for an organization that provides managed Medicaid health insurance. Requires an ..
Description The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All ..
Description Role is open to US Remote This role will include managing a team of DevSecOps engineers, architects, testers, developers, and specialists who build and support our application security orchestration platform. ..
Description Humana is a $90 billion (Fortune 40) market leader in integrated healthcare with a clearly defined purpose to help people achieve lifelong well-being. As a company focused on the health ..
Description The Medical Director's primary responsibility is the review of medical authorizations or claims to determine the medical necessity of a given service or level of care. The Medical Director's work ..
Description The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations. The Behavioral Health Medical Director work assignments involve moderately complex to complex issues where the analysis of ..
Description The Associate Director, Infrastructure Engineering scope of responsibility includes ensuring the technical foundation for Virtualization, Operating Systems, Security, and support of cloud environments. Develops the organization's infrastructure and Obsolescence plans, ..
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 ..
Description Responsibilities The Insurance Product Manager 2 will: Research each State's Medicaid rules, as it pertains to base benefits, expanded benefits, competitive analysis, etc. for intelligence gathering and strategy formulation Responsible ..
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 ..
Description The Senior Project Manager, Medicaid Provider & Network Implementation (remote) is accountable for working with the Director, Provider & Network Implementation to assist with driving efficient management of end-to-end provider-related ..
Job Information Humana Manager, Compliance - Agent Investigation Unit in Aberdeen South Dakota Description The Manager, Compliance ensures compliance with governmental requirements. The Manager, Compliance works within specific guidelines and procedures; ..
Description The Value-Based Programs Strategy Lead supports the creation of complex value-based programs. The Value-Based Programs Lead provides strategic advice and guidance to functional team(s) related to value-based vendor and specialty ..
