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Description The Risk Adjustment Representative 2 conducts quality assurance audits of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other ..
... review team is seeking a Medical Coding Auditor with a special ... review information provided in the medical records they must understand what ... this information confidently to other..
Job Information Humana Care Team Medical Director in Glen Allen Virginia ... Virginia Description The Care Team Medical Director is responsible for improving ... ground up. The Care Team Medical..
Job Information Humana FP&A Lead, Medicaid Market in Glen Allen Virginia Description The Financial Planning & Analysis Lead is acritical leadership role with full market financial oversight over the South Carolina ..
... team of 20-25 nurses and medical professionals that performs the following ... that performs the following functions: medical necessity/level of care reviews, provider ... education on the utilization and..
... coordination, documentation and communication of medical services and/or benefit administration determinations. ... in reviewing actual and proposed medical care and services against established ... against established CMS and Humana..
Description The Medical Director relies on fundamentals of ... C Line of Business. The Medical Director provides medical interpretation and determinations whether services ... a rotating basis Responsibilities The Medical..
... monitors drug development pipeline, and medical literature, while providing clinical support ... coverage policies for pharmacy and medical administered drug products. This individual ... Preferred Qualifications Board Certified Pharmacotherapy..
Description The Medical Director relies on medical background and reviews health claims. ... and reviews health claims. The Medical Director work assignments involve moderately ... Government Business's (HGB) Behavioral Health..
... Certified Diabetes Care and Education Specialist-Remote-US in Glen Allen Virginia Description ... Certified Diabetic Care and Education Specialist (CDCES) delivers comprehensive and seamless ... Certified Diabetes Care and Education..
Description The Medical Record Retrieval Specialist (Risk Adjustment Representative) travels to ... within the region and scans medical records into a secure system. ... day of employment. Benefits include: Medical..
Oncology Business Specialist -- Richmond, VA Do you ... to turning innovative science into medical solutions that bring value and ... our focus on addressing unmet medical needs and conducting..
Description Responsibilities As part of the Service Fund Specialty Load Team, the Senior Provider Installation Professional will work directly with our national and market contracting teams to influence specialist contract terms ..
Job Information Humana Senior Fraud and Waste Investigator-- REMOTE/WORK AT HOME in Glen Allen Virginia Description Humana is looking for an experienced Senior Healthcare Investigator to join its industry leading Special ..
Performance Improvement Consultant - Healthcare Revenue Cycle Services Overview of Position The Performance Improvement Consultant leads process improvement projects within the business unit and of moderate to high complexity. This role ..
Description The UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on ..
Job Information Humana Fraud and Waste Investigator - Work At Home (Anywhere in the US) in Glen Allen Virginia Description Humana is looking for an experienced Healthcare Investigator to join its ..
... Information Humana Manager, Pharmacy and Medical Trend in Glen Allen Virginia ... drug trends, both pharmacy and medical, as well as the impact ... Humana profitability. Responsibilities Lead our..
... package includes: competitive salaries, excellent medical, dental, and vision benefits, paid ... of the supervising physician and/or Medical Director. Functions with specific privileges ... Accountabilities Performs physical examination, compiles..
... iCare is seeking an Enrollment Specialist who will support the iCare ... BadgerCare Plus. Responsibilities The Enrollment Specialist is responsible for iCare enrollment ... more years' experience in the..
... The Supervisor, Pre-Authorization Nursing: Completes medical necessity and level of care ... Educates providers on utilization and medical management processes. Enters and maintains ... pertinent clinical information in various..
Job Information Humana Senior Clinical Pharmacy Advisor, Clinical Program Innovation in Glen Allen Virginia Description The Senior Pharmacy Clinical Advisor will be part of an interactive team with broad exposure and ..
Description The Behavioral Health Medical Director responsible for behavioral health ... and/or operations. The Behavioral Health Medical Director work assignments involve moderately ... Government Business's (HGB) Behavioral Health Medical Director..
