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... 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..
... 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..
... 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 .....
Description RN - Provider Clinical Liaison contributes to administration of utilization management. The RN - Provider Clinical Liaison work assignments involve moderately complex to complex issues where the analysis of situations ..
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 The Senior Stars Improvement, Clinical Professional responsible for the development, implementation and management oversight of the company's Medicare/Medicaid Stars Program. The Senior Stars Improvement, Clinical Professional work assignments involve moderately ..
Description The Referrals Coordinator 2 process referrals from Military Treatment Facilities (MTFs) and civilian providers. The Referrals Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically ..
... 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..
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 ..
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 ..
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 ..
Job Information Humana Social Worker-MSW and licensure ... for optimal performance from Humana systems is 25M x 10M Associates ... (see details below under Additional Information) and upon offer will..
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. ..
... 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..
... Medical Coding Auditor extracts clinical information from a variety of medical ... clarifies internal requests for medical information. Understands department, segment, and organizational ... or job related certification Additional..
... 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..
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 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, ..
... of services provided by other healthcare professionals in compliance with review ... whether services provided by other healthcare professionals are in agreement with ... management organizations, hospitals/ Integrated Delivery..
Job ID 21000HLPAvailable 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. ..
... 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..
Job ID 21000HL6Available 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. ..
