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... The SA role embodies our medical mission in becoming a trusted, ... science or accelerate access, optimize medical practice and drive appropriate adoption ... composed of field-based and home-office..
Description The Medical Director relies on medical background and reviews health claims. ... and reviews health claims. The Medical Director work assignments involve moderately ... of variable factors. Responsibilities The..
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 Staff Utilization Management Pharmacist is a clinical pharmacist who completes medical necessity and comprehensive medication reviews for prescriptions requiring pre-authorization. The Staff Utilization Management Pharmacist work assignments involve moderately ..
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 Medical Coding Auditor reviews medical records to verify coding (ICD-10 ... verify coding (ICD-10 CM/PCS). The Medical Coding Auditor work assignments are ... Where you Come In The..
Description Responsibilities The Compliance Professional 2 has responsibilities for performing clinical audits on medical record documentation for quality and clinical compliance with contract requirements as outlined in the Autism Care Demonstration ..
Job Information Humana Market Leadership Advisor (Managed/Health Care Industry) San Juan, PR in San Juan Puerto Rico Description The Market Leadership Advisor manages the development, operations, and results of a health ..
... audit/validation processes to ensure that medical record documentation and diagnosis coding ... and investigating clinical/coding information, researching medical materials and sources in order ... audit/validation process to ensure that..
Description Responsibilities The Autism Care Demonstration (ACD) Senior Learning Design Professional analyzes content, organizes content, designs solutions, and writes storyboards, scripts, performance support, newsletters and notification letters. Analyzes learning needs and ..
Description The Medical Director relies on medical background and reviews health claims. ... and reviews health claims. The Medical Director work assignments involve moderately ... factors. Responsibilities Job Profile The..
... individual's comprehensive health needs through communication and available resources to promote ... promote quality, cost-effective outcomes. Coordinate medical, behavioral and other services for ... efficient manner in accordance with..
Description The Care Manager, Telephonic Behavioral Health 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward ..
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 Wellness Coach 2 supports health promotion and disease prevention and care management services. The Wellness Coach 2 work assignments are varied and frequently require interpretation and independent determination of ..
Description The Clinical Recruiter recruits and interviews prospective employees for hourly and salaried positions for our Care Delivery Organization. Humana is seeking a recruiter who is a self-starter, able to work ..
Description The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments ..
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. ..
