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Description The Senior Provider Engagement, Clinical Professional develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve financial and quality performance within the ..
Description The Provider Contracting Professional 2 initiates, negotiates, and executes dental provider contracts and agreements for an organization that provides health insurance. The Provider Contracting Professional 2 work assignments are varied ..
Description The Associate Director, Vendor Management works as liaison between vendors and organization. The Associate Director, Vendor Management requires a solid understanding of how organization capabilities interrelate across department(s). Responsibilities The ..
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 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 ..
Description Humana Special Needs Plans provide personalized guidance and resources to help members get the right care and information based on their specific condition or needs. Beneficiaries qualify with the following ..
Job Information Humana Sales Support Representative - Honolulu, HI in Honolulu Hawaii Description Are you passionate about contributing to the well-being of the Medicare population? Would you like to provide support ..
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 ..
Description Humana has articulated a long-term vision to transform from a health insurance company to a health services company distinguished by the prioritization of the health outcomes and care experiences 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 Care Coach 1 assesses and evaluates member's needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the ..
Description The Large Group Medical Underwriter computes rates for both renewing and prospective moderate to complex group accounts. The Large Group Underwriter 2 work assignments are varied and frequently require interpretation ..
Description The Actuary, Analytics/Forecasting will develop the financial forecast for the dental and vision benefits included within Humana's growing Medicare Advantage business, as well as pricing and oversight of other stand ..
... that our members receive quality healthcare at an affordable price. You ... (RN) license 3 years of healthcare experience within a fraud investigations ... well as solid knowledge of..
Description As the Associate Director, IT Project Management, you will use your background and experience in program management to lead and manage a team of PMO professionals that support the delivery ..
Job Information Humana Medicaid Associate Director, Compliance Nursing in Honolulu ... in Honolulu Hawaii Description The Associate Director, Compliance Nursing reviews utilization ... fraud, waste, and abuse. The Associate Director,..
... roadmaps. Working closely with the Associate Vice President of Pharmacy Product ... insights Bachelor's degree in Business, Healthcare Administration or other related fields ... 50 market leader in integrated..
Description As Lead Actuary of the Risk Predictive Models team, you have an opportunity to both learn more about predictive analytics and machine learning and to see it become very real ..
Job Information Humana Social Worker-MSW and licensure required- Telephonic Behavioral Health-SNP- WAH Nationwide in Honolulu Hawaii Description The Care Manager, Telephonic Behavioral Health 2 , in a telephonic environment, assesses and ..
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 ..
Description The Financial Analytics Professional 2 manages data to support and influence decisions on day-to-day operations, strategic planning and specific business performance issues. The Financial Analytics Professional 2 work assignments are ..
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 The Associate Director, Consumer Engagement oversees the enrollment, education, engagement, and activation duties for client groups regardless of segment, and for product where warranted. The Associate Director, Consumer Engagement requires ..
