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... coordination, documentation, and communication of medical services and/or benefit administration determinations. ... appropriate criteria to make a medical necessity determination. Complete telephonic, faxed, ... Case Management Discuss cases with..
Description The Chief Medical Officer, Group Medicare relies on the medical background to create and oversee clinical strategy for the Group Medicare business. The CMO Group Medicare, requires and in-depth understanding ..
... coordination, documentation, and communication of medical services and/or benefit administration determinations. ... Behavioral Health Professional 2 completes medical record reviews from medical records sent from Behavioral Health ... appropriate..
Job Information Humana Care Team Medical Director in Fargo North Dakota Description ... Dakota Description The Care Team Medical Director is responsible for improving the ... unique opportunity to be..
... Healthy Horizons is seeking a Medical Director to help develop and execute ... develop initiatives to address women's medical and behavioral needs for adolescents, ... role requires strong collaboration..
Description The Medical Director relies on fundamentals of CMS ... and reviewing appeals for Medicare Part C Line of Business. The ... C Line of Business. The Medical Director provides..
Job Information Humana Oncology Market Director in Fargo North Dakota Description ... North Dakota Description The Market Director, Oncology leverages targeted geographic analysis, ... Pharmacy for fulfillment. The Market Director,..
Description The Medical Director relies on medical background and reviews health claims. ... and reviews health claims. The Medical Director work assignments involve moderately complex ... of variable factors. Responsibilities..
Job Information Humana Quality Improvement Program Lead (National Medicaid Quality) in Fargo North Dakota Description Humana Healthy Horizons is seeking a Quality Improvement Program Lead who will be responsible for the ..
... the BH Supervisor/ Manager or Director Required Qualifications Experience working with ... investigative skills Excellent organizational and time management skills Strong attention to ... with clear direction and as..
Job Information Humana Nationwide Medicaid Behavioral Health Quality Lead in Fargo North Dakota Description The Behavioral Health Quality Lead will report directly to the National Medicaid Quality Director, and be responsible ..
... Humana Medicare Appeals and Grievance Medical Director in Fargo North Dakota Description ... Fargo North Dakota Description The Medical Director relies on fundamentals of CMS ... and reviewing appeals..
Job Information Humana Associate Director, Technology Solutions in Fargo North ... in the role of Associate Director, Technology Solutions to as a ... training, etc. Reports to a Director in..
Job Information Humana Lead Product Manager - Healthcare API in Fargo North Dakota Description The Lead Product Manager - Healthcare API (SME) as part of Humana's Enterprise API product team, is ..
... for performing clinical audits on medical record documentation for quality and ... support the submitted charges. Comprehensive medical records review will be conducted ... assigned by Supervisor, Manager and/or..
Description The Director, Pharmacy Clinical Pipeline oversees the ... Pharmacy Clinical Pipeline oversees the medical and pharmacy drug pipeline tracking ... and finance teams. Responsibilities The Director, Pharmacy Pipeline requires..
Job Information Humana Nationwide Associate Director, Utilization Management Nursing in Fargo ... North Dakota Description The Associate Director, Utilization Management Nursing utilizes clinical ... coordination, documentation and communication of medical..