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... 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 Montpelier Vermont Description ... Vermont Description The Care Team Medical Director is responsible for improving ... ground up. The Care Team Medical..
... Information Humana Manager, Pharmacy and Medical Trend in Montpelier Vermont Description ... drug trends, both pharmacy and medical, as well as the impact ... Humana profitability. Responsibilities Lead our..
... guidelines, enjoys researching and reviewing medical record documentation for incorrect billing ... Auditor 2 validates and interprets medical documentation to ensure capture of ... residence Minimum 2 years of..
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..
... 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..
Job Information Humana FP&A Lead, Medicaid Market in Montpelier Vermont Description The Financial Planning & Analysis Lead is acritical leadership role with full market financial oversight over the South Carolina Medicaid ..
... Windham County, VT . This office services our adult and geriatric ... at home and receive the medical care required. Registered Nurse (RN) ... and reliability. Benefits may include..
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..
... Coders are responsible for reviewing medical records, completing multiple audits, and ... while analyzing coding information and medical records. May participate in provider ... be used as a home..
... 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..
... 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..
... 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..
Job Information Humana Fraud and Waste Investigator - Work At Home (Anywhere in the US) in Montpelier Vermont Description Humana is looking for an experienced Healthcare Investigator to join its industry ..
Job Information Humana Strategy Advancement Lead - Humana Care Management in Montpelier Vermont Description The Strategy Advancement Lead provides data-backed strategic direction to identify and address business issues and opportunities related ..
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..
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 ..
... assignment capsule includes reviewing of medical records for fraud, waste or ... well as review of Humana Medical Coverage Policies, CMS regulations, peer ... vaccination or documentation for a..
... 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..
... recommendations. Participates as the health specialist on school teams (i.e. safety ... nursing practices. Utilizes equipment for medical diagnosis and treatment, general office equipment (including the computer) for .....
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 Senior Clinical Pharmacy Advisor, Clinical Program Innovation in Montpelier Vermont Description The Senior Pharmacy Clinical Advisor will be part of an interactive team with broad exposure and scope ..
Job Information Humana Senior Fraud and Waste Investigator-- REMOTE/WORK AT HOME in Montpelier Vermont Description Humana is looking for an experienced Senior Healthcare Investigator to join its industry leading Special Investigations ..