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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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Description The Behavioral Health Care Coordinator, 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 facilitate interaction ..
Description The Quality Assurance, Clinical Professional 2 consults and collaborates with clinicians to ensure high accountability of compliance and quality. The Quality Assurance, Clinical Professional 2 work assignments are varied and ..
... acumen to solve for the healthcare challenges of today. The Clinical ... low value care and related healthcare resource waste, with a focus ... news and reports in the..
Description Responsibilities The Senior Quality Assurance (Home Health) Clinical Professional consults and collaborates with clinicians/nurses to ensure high accountability of compliance and quality and claims are being reviewed correctly. This position ..
Description The Care Management Support Assistant 2 (CMSA2) contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain ..
Description Humana's Enterprise Clinical Management team needs your clinical, business and analytics acumen to solve for the healthcare challenges of today. The Clinical Analytics and Trend team uses advanced scientific techniques, ..
u003cpu003eu003cstrongu003eRole Summary:u0026nbsp; u0026nbsp;u003c/strongu003eu003c/pu003enu003cpu003eThe Prior Authorization Nurse Analyst is a work from home position that will assist in reviewing medical documentation for prior authorization requests submitted.u003c/pu003enu003cpu003eu003cstrongu003eIn this role you will:u003c/strongu003eu003c/pu003enu003culu003enu003cliu003ePerform review of ..
Description The Senior Quality Assurance, Clinical Professional requires being both a nurse/RN and a certified Coder nurse as this position will be cross trained to review DRG (Diagnosis Related Group) audits ..
u003cpu003eu003cstrongu003eRole Summary:u0026nbsp; u003c/strongu003eu003c/pu003enu003cpu003eThe Clinical Supervisor (RN) will oversee a team of 20 to 30 remote Medical Review Nurseu0026nbsp; Analysts (NA) that complete Targeted Probe and Educate (TPE) work for our Medicare ..
Description The Lead Medical Director relies on medical background and reviews health claims. The Lead Medical Director requires a solid understanding of how organization capabilities interrelate across department(s). Responsibilities The Lead ..
