EmploymentCrossing Jobs

Director, Group Provider Strategy - South - USA-DC-Washington

Mon, 26 Jun 2023 00:00:00 CDT

Description The Director, Group Provider Strategy partners with the assigned Employer Group Market Presidents within the Region on the Employer Group provider strategy, provider performance and healt...

Director, Group Market Operations - South - USA-DC-Washington

Mon, 26 Jun 2023 00:00:00 CDT

Description The Director, Group Market Operations partners with the assigned Group Market Presidents on cost of care and profitable growth management, risk management and operations. The Market Opera...

Director, Group Provider Strategy - North - USA-DC-Washington

Mon, 26 Jun 2023 00:00:00 CDT

AVP Business Technology Solution Implementation - USA-DC-Washington

Mon, 26 Jun 2023 00:00:00 CDT

Description The AVP, Business Technology Solutions Implementation will oversees various system programs of a highly complex nature to deliver new technological solutions to meet business needs within...

Director, National Medicaid Care Management Strategy and Practice - USA-DC-Washington

Mon, 26 Jun 2023 00:00:00 CDT

Description As Humana's Medicaid membership continues to grow, the National Medicaid Clinical Operations team is expanding our shared services organization to enhance the clinical delivery process. T...

Enterprise Clinical Operating Model (ECOM) Intern - USA-DC-Washington

Mon, 26 Jun 2023 00:00:00 CDT

Description The Intern - General 2 performs duties in field of study or profession. The Intern - General 2 performs varied activities and moderately complex administrative/operational/customer suppor...

Account Manager - USA-DC-Washington

Mon, 26 Jun 2023 00:00:00 CDT

Description Enclara, is a wholly owned hospice and palliative care pharmacy business acquired by Humana in 2021. Enclara is the nation's largest full-service pharmacy benefits manager (PBM) specifica...

Medical Director - Part Time - USA-DC-Washington

Mon, 26 Jun 2023 00:00:00 CDT

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 situa...

Director, Group Market Operations - North - USA-DC-Washington

Mon, 26 Jun 2023 00:00:00 CDT

UM Administration Coordinator 1 - USA-DC-Washington

Mon, 26 Jun 2023 00:00:00 CDT

Description The UM Administration Coordinator 1 contributes to administration of utilization management. The UM Administration Coordinator 1 performs basic administrative/clerical/operational/custome...

Staff Utilization Management Pharmacist (Contract Position) - USA-DC-Washington

Mon, 26 Jun 2023 00:00:00 CDT

Description The Staff Utilization Management Pharmacist is a clinical pharmacist who completes medical necessity and comprehensive medication reviews for prescriptions requiring pre-authorization. Th...

Utilization Management RN (DME / HH Outpatient) - WAH - USA-DC-Washington

Mon, 26 Jun 2023 00:00:00 CDT

Description The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determin...

Nurse Auditor 2/RN (Coding and Home Health Field exp a MUST) Work At Home - USA-DC-Washington

Sun, 13 Aug 2023 00:00:00 CDT

Description The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate...

Medical Director - Work at Home - USA-DC-Washington

Wed, 30 Aug 2023 00:00:00 CDT

Manager, Utilization Management Nursing - Medicare / Medicaid - USA-DC-Washington

Sun, 13 Aug 2023 00:00:00 CDT

Job Information Humana Manager, Utilization Management Nursing - Medicare / Medicaid in Washington District Of Columbia Description The Manager, Utilization Management Nursing utilizes clinical nursin...

Pharmacy Clinical Integration - Senior Technology Implementation Professional - USA-DC-Washington

Thu, 06 Jul 2023 00:00:00 CDT

Description The Senior Technology Implementation Professional manages implementations for new real time benefit connections, and maintains existing vendor connections. This role manages the vendor co...

Senior Pre-Authorization Nurse - USA-DC-Washington

Mon, 11 Sep 2023 00:00:00 CDT

Description The Senior Pre-Authorization Nurse reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to t...

Associate Director, Provider Data Interoperability - USA-DC-Washington

Fri, 25 Aug 2023 00:00:00 CDT

Job Information Humana Associate Director, Provider Data Interoperability in Washington District Of Columbia Description Humana's Provider Data and Medicaid Governance team is committed to effective a...

Care Management Support Assistant-SNP- WAH Nationwide - USA-DC-Washington

Mon, 26 Jun 2023 00:00:00 CDT

Description The Care Management Support Assistant 2 contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements...

Associate Attorney needed for Washington, DC office - USA-DC-Washington

Wed, 24 Apr 2024 00:00:00 CDT

A law firm in Washington, DC is seeking an experienced Associate Attorney with a strong background in health care and life science (HCLS) law. The ideal candidate should have a minimum of 3 years o...