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Description The Medical Director relies on medical background and reviews health claims. ... and reviews health claims. The Medical Director work assignments involve moderately complex ... variable factors. Responsibilities Job..
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... 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..
... drug manufacturers and providers. The Director, Pharmacy Clinical Formulary and Medical Strategies requires a broad understanding ... execute on the formulary and medical drug strategies. Responsibilities The Director, Pharmacy..
Description The Medical Director relies on medical background and reviews health claims. ... and reviews health claims. The Medical Director work assignments involve moderately complex ... factors. Responsibilities Job Profile..
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..
... brand for a primary care medical group practice with centers open ... of care. Follows level of medical care and quality for patients ... hospital and SNF coordination, durable..
Description The Senior Pharmacy Sales Executive leverages targeted geographic analysis, engages with Physician offices to influence physicians to route patients' prescriptions to Humana Pharmacy for fulfillment. The Senior Pharmacy Sales Executive ..
Description The Vendor Quality Medical Director will manage clinical vendor quality ... Team. Responsibilities A full time Medical Director to manage clinical vendor quality ... to review quality audit findings,..
Description The Associate Director, Utilization Management Nursing utilizes clinical ... coordination, documentation and communication of medical services and/or benefit administration determinations. ... benefit administration determinations. The Associate Director, Utilization Management..
... Evaluate the element of the medical record for diagnosis code selection ... Query providers to obtain additional medical record documentation or to clarify ... matrix environment of coding educators,..
Description The Clinical Pharmacy Lead monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders. Utilizes broad understanding of managed care and PBM knowledge to develop, and/or ..
Description The UM Administration Coordinator contributes to administration of utilization management. The UM Administration Coordinator performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. ..
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 Compliance Nurse 2 reviews medical management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Compliance Nurse ..
Description The Medical Director actively uses their medical background, experience, and judgement to ... conferences, and other reference sources. Medical Directors will learn Commercial requirements ... daily work. Responsibilities Title:..
