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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 ..
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Description The Care Coach 1 assesses and evaluates member's needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the ..
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 ..
... 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 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 ..
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 21000E8SAvailable 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 Humana Military, a wholly-owned subsidiary of Humana Inc. headquartered in Louisville, KY, partners with the Department of Defense to administer the TRICARE health program for military members, retirees and their ..
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 ..
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 ..
Description The Financial Analytics Professional 2 manages data to support and influence decisions on day-to-day operations, strategic planning and specific business performance issues. The Financial Analytics Professional 2 work assignments are ..
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 ..
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 Information Humana Care Manager, Telephonic Behavioral Health 2 - Remote, US in Newport Rhode Island Description Humana Military, a wholly-owned subsidiary of Humana Inc. headquartered in Louisville, KY, partners with ..
Outreach Peer Recovery Specialist (Full Time and Part Time) Location: Woonsocket, RI The Serenity Center/Safe Haven is a thriving Recovery Community Center, providing recovery supports to individuals in the Northern RI ..
Description The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. The ..
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 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 ..
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. ..
... 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 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 Come join the Digital Health & Analytics (DH&A) team within Humana to build a world class Data Science and Insights enterprise capability leveraging digital-first platforms, analytics, and agile development methodologies. ..
