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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 ..
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Description The Care Manager, Telephonic Behavioral Health 2 , ... wellbeing of members. The Care Manager, Telephonic Behavioral Health 2 work ... of action. Responsibilities The Care Manager, Telephonic Behavioral..
... of services provided by other healthcare professionals in compliance with review ... issues regarding technical approach for project components, and work is performed ... whether services provided by other..
Description The Manager, Fraud and Waste, Genetic Counseling provides clinical support for investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste, Genetic Counseling works within specific guidelines ..
Job Information Humana Medical Director - Texas in Jersey City New Jersey Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately ..
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 ..
... of services provided by other healthcare professionals in compliance with review ... issues regarding technical approach for project components, and work is performed ... working with health insurance other..
Job Information Humana Medical Director of Trend Analytics in Jersey City New Jersey Description Humana's ECM organization is seeking a Medical Director of Trend Analytics. As a clinical trend leader you ..
Job Information Humana Manager, Fraud and Waste-Remote US in ... City New Jersey Description The Manager, Fraud and Waste conducts investigations ... fraudulent and abusive practices. The Manager, Fraud and..
Description The Hospital Engagement Executive will interface with contracted Hospital Systems in the Northeast to support our growth and profitability objectives. This person represents the Humana/Hospital relationship internally and externally across ..
Job Information Humana Senior Care Manager, Behavioral Health (BCBA) in Jersey City New Jersey Description Responsibilities The Senior Care Manager, Behavioral Health (BCBA) is responsible for the administration and monitoring of ..
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 Job Description Summary 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 ..
Job Information Humana UM Medical Director - Conviva in Jersey City New Jersey Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve ..
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 Assist local pharmacies with claims adjudication to support medication access for HC & LTC hospice patients; reconcile historic billing issues. Responsibilities There are 4 shifts available for this role. All ..
Job Information Humana Nationwide Associate Director, Utilization Management Nursing in Jersey City New Jersey Description The Associate Director, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and ..
Job Information Humana Manager, Pharmacy and Medical Trend in Jersey City New Jersey Description This leader will oversee a team charged with monitoring, reporting and projecting Humana's drug trends, both pharmacy ..
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 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 ..
