Healthcare Credentialing Jobs

... We are the future of healthcare and our mission is to ... will help members through their healthcare journey, ensuring they get the ... are: Passionate about transforming our..

Job Information Humana Senior Clinical Recruiter in Fargo North Dakota Description The Senior Clinical Recruiter recruits qualified applicants for staff nurse or other positions requiring registered nurse licensure, licensed practical nurse, ..

... 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,..

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'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 ..

... whether services provided by other healthcare professionals are in agreement with ... whether services provided by other healthcare professionals are in agreement with ... organizations, and able to pass..

Job Information Humana Medicare Appeals and Grievance Medical Director in Fargo North Dakota Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare ..

Job Information Humana Network Operations Lead - Behavioral Health/Medicaid in Fargo North Dakota Description The Network Operations Lead maintains provider relations to support customer service activities through data integrity management and ..

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 ..

Job Information Humana Medical Director - Texas in Fargo North Dakota Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..

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 ..

... 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..

n n Helpn n Requirementsn Conditions of Employmentn n n n ntYou must be a U.S. Citizen to apply for this job.ntSelective Service Registration is required for males born after 12/31/1959.ntMust ..

Job Information Humana UM Medical Director - Conviva in Fargo North Dakota Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately ..

Position: ENTnLocation: Fargo, NDnnMPLT Healthcare is looking for physicians who ... benefits of working with MPLT Healthcare include:nnn Flexibility u2013 work when, ... access to your personal MPLT Healthcare consultantn..

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 ..

Job Information Humana Medical Director - Medicare Pharmacy Appeals in Fargo North Dakota Description The Medical Director relies on clinical background and reviews Medicare drug requests. The Medical director work assignments ..

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 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 ..

Job Information Humana Strategy Advisor, Healthcare Strategy in Fargo North Dakota ... Dakota Description The Strategy Advisory, Healthcare Strategy provides data-based strategic direction ... Responsibilities Humana: A Fortune 100 Healthcare..

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 ..

... of services provided by other healthcare professionals in compliance with review ... whether services provided by other healthcare professionals are in agreement with ... organizations, and able to pass..

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 ..