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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 ..
... Qualifications AAPC or AHIMA coding certification required; CPC, CPC-A, or CCS ... in good standing with the certification governing body Effective written and ... is in a Work At..
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 Troy Michigan Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..
... American Board of Medical Specialty certification is psychiatry Preferred Qualifications Experience ... and/or special projects. Work at Home Guidance To ensure Home or Hybrid Home/Office associates' ability to work..
Job Information Humana Medical Director - Medicare Pharmacy Appeals in Troy Michigan Description The Medical Director relies on clinical background and reviews Medicare drug requests. The Medical director work assignments involve ..
Description The RN Clinical team is looking for a dynamic Registered Nurse to join the team working remote anywhere in the US or in Louisville, KY! We are looking for someone ..
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 ..
... Waste Investigator - Work At Home (Anywhere in the US) in ... or work outside of their home. If progressed to offer, you ... exemptions are available. Work at..
Description The Lead Behavioral Health Medical Director oversees the work of 2 Medical Directors who conduct clinical case reviews of the care received by members in an assigned market, member population, ..
... and Waste Investigator-- REMOTE/WORK AT HOME in Troy Michigan Description Humana ... or work outside of their home. If progressed to offer, you ... exemptions are available. Work at..
Job Information Humana Medicare Appeals and Grievance Medical Director in Troy Michigan Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part ..
... degree Current and ongoing board certification in an approved ABMS Medical ... Lead Medical Director Work at Home Guidance To ensure Home or Hybrid Home/Office associates' ability to work..
... Required Qualifications AAPC or AHIMA certification required (CPC-A, CPC, CCS, CCA) ... in good standing with the certification governing body Must be willing ... and some overtime Work At..
Description Job Description Summary 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 ..
Job Information Humana Medical Director - National Medicare Team in Troy Michigan Description The Medical Director relies on medical background and reviews preauthorization requests for services. The Medical Director work assignments ..
... Strategy Pharmacist - Work At Home in Troy Michigan Description Responsibilities ... appropriate state Must have Board Certification Clinical experience in managed care ... Preferred Qualifications Board Certified Pharmacotherapy..
Description The Supervisor, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Supervisor, Compliance ..
Job Information Humana Medical Director - Florida Medicaid in Troy Michigan Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..