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Bristol-Myers Squibb is a global Biopharma company committed to a single mission: to discover, develop, and deliver innovative medicines focused on helping millions of patients around the world in disease areas ..
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Description The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within ..
Description The Principal Quality Leader will lead testing and quality collaboration between Business and IT, guiding test strategies and tools and assure adherence to quality standards. Serves as point of contact ..
Job ID 21000IZGAvailable Openings 2PURPOSE 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. ..
Job ID 21000IURAvailable 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 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 ..
... 60 market leader in integrated healthcare with a clearly defined purpose ... us redefine the future of healthcare. With a history of transformation ... about solving big problems in..
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 ID 21000JOVAvailable 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 Responsibilities This role within the Autism Care Demonstration (ACD) Team, will work closely with Care Management leaders and Subject Matter Experts in the areas of Case Management, Utilization Management and ..
... and services. Partners closely with operations, vendors, customer success teams and/or ... insights Bachelor's degree in Business, Healthcare Administration or other related fields ... 50 market leader in integrated..
Description Humana Special Needs Plans provide personalized guidance and resources to help members get the right care and information based on their specific condition or needs. Beneficiaries qualify with the following ..
Job ID 21000J9MAvailable Openings 2PURPOSE 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 Vendor Quality Medical Director will manage clinical vendor quality outcomes for Humana Clinical Operations Team. Responsibilities A full time Medical Director to manage clinical vendor quality outcomes for Humana ..
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. ..
Job ID 21000GMEAvailable Openings 1 PURPOSE AND SCOPE: The registered professional nurse (CAP RN 1) position is an entry level designation into the Clinical Advancement Program for Registered Nurses. The CAP ..
Description The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management ..
Job ID 21000ITWAvailable 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 Business Professional is a clinical partner to the Commercial Product Strategy team. The Senior Clinical Business Professional work assignments involve moderately complex to complex issues where the ..
Job ID 21000GOYAvailable Openings 1 PURPOSE AND SCOPE: Functions as part of the hemodialysis health care team in providing safe and effective dialysis therapy for patients under the direct supervision of ..
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 ..
Job ID 21000H22Available 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 Responsibilities Humana's Corporate Strategy team is a small, high-performing organization that works closely with Humana's senior leadership to chart the course for the company's future. Within Strategy Operations, you will ..
