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Case Manager The candidate provides Child Support Services by managing a caseload to obtain results for customers that include but are not limited to establishing paternity and medical and child support ..
Description Responsibilities Humana's Primary Care Organization is one of the largest and fastest growing value-based, senior primary care groups in the country, providing care to over 200,000 seniors across 175 sites ..
Description Provides executive leadership to Humana. Responsibilities Humana's Primary Care Organization is one of the largest and fastest growing value-based, senior primary care groups in the country, providing care to over ..
Description The Senior Professional collaborates with healthcare professionals, pharmacists, and other business functions to implement formulary and medical strategies for the Medicaid line of business. Makes decisions on moderately complex to ..
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 ..
Description The Medical Director's primary responsibility is the review of medical authorizations or claims to determine the medical necessity of a given service or level of care. The Medical Director's work ..
Description The Director, Pharmacy Clinical Formulary and Medical Drug Strategies oversees and drives the pharmacy and medical drug formulary strategies across all lines of business (Medicare, Commercial, Medicaid). This position will ..
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 ..
Description Healthcare isn't just about health anymore. It is about caring for family, friends, finances, and personal life goals. It's about living life fully. At the Primary Care Organization, a division ..
Description The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations. The Behavioral Health Medical Director work assignments involve moderately complex to complex issues where the analysis of ..
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 ..
Description The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Medical Coding ..
Description The Behavioral Health Medical Director makes determinations regarding prior authorization and retrospective reviews for inpatient and outpatient services to ensure that members receive clinically appropriate and medically necessary services. All ..
Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health episodic and per diem requests. The Medical Director provides medical interpretation and determinations whether ..
Job Information Humana AVP, Stars and Risk Adjustment National Medical Director in Lancaster South Carolina Description The Healthcare Quality Reporting & Improvement (HQRI) organization is seeking a talented Physician executive that ..
Description The Medical Coding Coordinator 3 extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Medical ..
