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... Humana Senior Process Improvement Professional (HealthCare, Provider Value exp.) Work at ... Medicaid business partners, including: Contracting, Credentialing, Referral/Authorizations, Claims, Grievance and Appeals, ... a Bachelor's degree in Business,..
Job ID 21000LDMAvailable Openings 1PURPOSE AND SCOPE: Supports FMCNA’s mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements. ..
Description The Senior Clinical Fraud and Waste Professional performs analysis of clinical investigations of allegations of fraudulent and abusive practices. The Senior Clinical Fraud and Waste Professional work assignments involve moderately ..
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 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 ..
PURPOSE AND SCOPE: Provides psychosocial services to patients treated by the facility including in-center and home dialysis patients (if applicable) utilizing Social Work Theory of Human Behavior and accepted methods of ..
Job Information Humana Manager, Credentialing in Dover Delaware Description Responsibilities ... a team of certification and credentialing professionals that to ensure required ... contract requirements. Work collaboratively with credentialing leaders..
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 ..
Summary: This individual functions under the guidance of the registered nurse and is responsible for performing scrub duties and maintaining quality patient care as a member of the Operating Room ..
Job Information Humana Supervisor, Credentialing in Dover Delaware Description Responsibilities ... Delaware Description Responsibilities The Supervisor, Credentialing Operations is responsible for supervising ... years of experience in provider credentialing and/or..
Description The Senior Professional, Medicaid Network Strategy will be accountable for supporting the development of Humana Healthy Horizon's (Medicaid) network and provider strategy for its growth markets. This strategist will provide ..
Job Information Humana Strategy Advisor, Healthcare Strategy in Dover Delaware Description ... Delaware Description The Strategy Advisory, Healthcare Strategy provides data-based strategic direction ... Responsibilities Humana: A Fortune 100 Healthcare..
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 ..
... of services provided by other healthcare professionals in compliance with review ... whether services provided by other healthcare professionals are in agreement with ... departments, Humana colleagues and the..
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 ..
Summary: Under the supervision and/or direction of the physician or nurse performs various duties assisting with the treatment and care of patients in accordance with established standards. Other information: Two ..
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 ..
