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... vision is to improve member healthcare through innovative analytics and actionable ... and suspected trend drivers Find contract provisions likely to have contract load issues Poorly worded outlier .....
Description The Senior Vendor Management Professional with Humana manages a diverse scope of complex vendor projects in collaboration with all areas of Claims Cost Mgt (CCM) in an effort to reduce ..
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 ..
... The Provider Contracting Executive communicates contract terms, payment structures, and reimbursement ... settlement arrangements (with finance)Delivers a contract that can be operationalized, and ... be operationalized, and maintained.Collaborates with..
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 Pharmacy Development Specialist will be responsible for qualifying and managing new business leads and cultivating prospects and sales. Responsibilities Summary The Business Development Specialist will be responsible for managing ..
Job Information Humana Medicare Appeals and Grievance Medical Director in Honolulu Hawaii Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part ..
Job Information Humana Medical Director - Florida Medicaid in Honolulu Hawaii Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..
Job Information Humana UM Medical Director - Conviva in Honolulu Hawaii Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..
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 The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health episodic and per diem requests. The Medical Director provides medical interpretation and determinations whether ..
Job Information Humana Medical Director - National Medicare Team in Honolulu Hawaii Description The Medical Director relies on medical background and reviews preauthorization requests for services. The Medical Director work assignments ..
Job Information Humana FP&A Lead, Medicaid Market in Honolulu Hawaii Description The Financial Planning & Analysis Lead is acritical leadership role with full market financial oversight over the South Carolina Medicaid ..
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 ..
Job Information Humana Finance Professional 2 - IT Finance (contract labor & capitalization) in Honolulu Hawaii Description The New Cost Pool Team within IT Finance (contract labor & capitalization) was been ..
... market contracting teams to influence specialist contract terms that align with Service ... in close coordination with PCP Contract Load, Capitation Rates, Payments, and ... Adjustments teams to ensure..
