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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 Information Humana Physician - CenterWell - Atlanta, GA - College Park in Springfield Missouri Description CenterWell Senior Primary Care, a subsidiary of Humana Inc., is the new brand for a ..
Job Information Humana Physician - CenterWell - Atlanta, GA in Springfield Missouri Description CenterWell Senior Primary Care, a subsidiary of Humana Inc., is the new brand for a primary care medical ..
Description The Associate Director, Clinical Pharmacy monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders. Utilizes broad understanding of managed care and PBM knowledge to develop, ..
Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part C Line of Business. The Medical Director provides medical interpretation and determinations ..
Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires ..
Job Information Humana UM Medical Director - Conviva in Springfield Missouri Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..
Job Information Humana Medicare Appeals and Grievance Medical Director in Springfield Missouri Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part ..
Description The Supervisor, Care Management Support contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness ..
Description The Director, Pharmacy Clinical Formulary and Medical Drug Strategies oversees and drives the pharmacy and medical drug formulary strategies across all lines of business (Medicare, Commercial, Medicaid). This position will ..
Description iCare is seeking an Enrollment Specialist who will support the iCare enrollment processing duties for all lines of business including Medicare, Medicaid, Family Care Partnership (FCP) and BadgerCare Plus. Responsibilities ..
Description Humana's Marketing organization is seeking an experienced Market Research Lead to join the Market Research Department working remote anywhere in the U.S. This is a newly added role that will ..
... is looking for an experienced Healthcare Investigator to join its industry ... areas Bachelor's degree or significant healthcare fraud and investigation experience At ... At least 1 year of..
Description The Supervisor, UM Administration contributes to administration of utilization management. The Supervisor, UM Administration works within thorough, prescribed guidelines and procedures; uses independent judgment requiring analysis of variable factors to ..
Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health episodic and per diem requests. The Medical Director provides medical interpretation and determinations whether ..
Description The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations. The Behavioral Health Medical Director work assignments involve moderately complex to complex issues where the analysis of ..
Job Information Humana Strategy Advancement Lead - Humana Care Management in Springfield Missouri Description The Strategy Advancement Lead provides data-backed strategic direction to identify and address business issues and opportunities related ..
