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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 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 ..
At GE Healthcare, our passionate people are creating the products, solutions and services our customers need to deliver the best patient care possible. Job Description Roles and Responsibilities Create vision 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 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 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 ..
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 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 Fraud Investigation Technician 2 conducts investigations of allegations of fraudulent and abusive practices. The Fraud Investigation Technician 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. ..
Description The Network Operations Coordinator 4 maintains provider relations ... provider data needed for service operations. The Network Operations Coordinator 4 assumes ownership and ... and judgment. Responsibilities The Network..
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 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 ..
Job ID 21000EZYAvailable Openings 3 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 ..
u003cpu003eu003cstrongu003eRole Summaryu003c/strongu003eu003c/pu003enu003cpu003eResponsible for agency sales and retention of senior product lines, as well as providing support to Agency Manager and sales team to achieve goals.u003c/pu003enu003cpu003eu003cstrongu003eIn this role you will:u003c/strongu003eu003c/pu003enu003culu003enu003cliu003eMaintain regular contact ..
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 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 Information Humana Care Manager, Telephonic Behavioral Health 2 - Remote, US in Green Bay Wisconsin Description Humana Military, a wholly-owned subsidiary of Humana Inc. headquartered in Louisville, KY, partners with ..
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 21000HSBAvailable 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. ..
... 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 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 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 ..
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 ..
