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Description The Process Improvement Lead analyzes, and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Process Improvement Lead works on problems of ..
... look for a Senior Business Systems Analyst to join working remote ... the US! The Senior Business Systems Analyst performs analysis of business, ... requirement specifications. The Senior Business..
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... take charge of their own healthcare decisions. Provide guidance and clinical ... coordinate interventions that may include information, education, resources and referrals Coordinate ... learn how to use virtual..
Description The Associate Director, Problem, Incident and Event Management drives technical support teams to recover services during periods of service disruption or outages to key technology platforms/applications. The Associate Director, Problem, ..
Description The Senior Product Manager conceives of, develops, delivers, and manages products for customer use. The Senior Product Manager work assignments involve moderately complex to complex issues where the analysis of ..
Description The Provider Contracting Executive initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Provider Contracting Executive works on problems ..
Description Responsibilities The Director, Provider Contracting initiates, negotiates, and executes physician, hospital, ancillary and/or other provider contracts and agreements for an organization that provides health insurance. The Director, Provider Contracting requires ..
... can complete or request additional information. Role Responsibilities Recognizes specific assessments/treatment ... civilian providers to obtain additional information that may be required to ... Processing) . Two years prior..
... phone to gather additional clinical information or discuss determinations regularly, and ... whether services provided by other healthcare professionals are in agreement with ... management organizations, hospitals/ Integrated Delivery..
Description The Senior Claims Research & Resolution Professional manages claims operations that involve customer contact, investigation, and settlement of claims for and against the organization. Approves all claims issues/complaints within contractual ..
Description The Director, Provider Contracting- Behavioral Health Medicaid initiates, negotiates, and executes physician, hospital, and/or other provider behavioral health contracts for an organization that provides managed Medicaid health insurance. Requires an ..
Description Responsibilities The Consumer Service Operations Professional 2 evaluates claims oversight performance metrics by interfacing with the sub-contractor to gather and track associated reporting. The Consumer Service Operations Professional 2 evaluates ..
... physicians, physician groups, and integrated healthcare delivery systems throughout the country. Healthcare isn't just about health anymore. ... of our members, and the healthcare industry as a whole. Responsibilities..
... into prepayment status. 30% Update systems with corrections to provider records ... Qualifications 2 plus years of healthcare experience Prior experience in Fraud, ... or Master's Degree in Business,..
... Administration support experience in a healthcare industry Familiarity with care and ... a contracting process, preferably in healthcare Effective negotiation skills Ability to ... learn new HR and reporting..
... phone to gather additional clinical information or discuss determinations regularly, and ... whether services provided by other healthcare professionals are in agreement with ... departments, Humana colleagues and the..
Job ID 21000IJPAvailable Openings 1Position Specific Information $1,000 Sign-on Bonus with no dialysis experience $1,500 Sign-on Bonus with dialysis experiencePURPOSE AND SCOPE: Supports FMCNA’s mission, vision, core values and customer service ..
Description Responsibilities The Utilization Management Nurse 2 will be responsible for performing clinical audits on medical record documentation for quality and clinical compliance with contract requirements as outlined in the Autism ..
... get the right care and information based on their specific condition ... related experience in management of healthcare analytical support staff Technical proficiency ... for optimal performance from Humana..
Description The Clinical Data and Reporting Professional 2 generates ad hoc reports and regular datasets and reporting for clinical leadership decision making. The Clinical Data and Reporting Professional 2 also pulls ..
... Facility to obtain sufficient clinical information for all levels of facility ... operations experience Knowledge of Humana systems and clinical programs Additional Information Interview Format As part of .....
... recruiting, and screening qualified home healthcare applicants within an assigned territory. ... non-exempt staff recruitment, preferably in healthcare Experience with applicant tracking systems and/or CRMs Experience using recruiting .....
Description The UM Administration Coordinator contributes to administration of utilization management. The UM Administration Coordinator performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. ..
