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Medical Director- South Central

Humana
Columbus, OH
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**Become a part of our caring community and help us put health first**The ...
Details
Summary
About the job:
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 work occurs within a context of regulatory compliance, and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare...
Location:
Columbus, OH
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Board Certified
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Medical Director- South Central

Humana
Saint Paul, MN
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**Become a part of our caring community and help us put health first**The ...
Details
Summary
About the job:
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 work occurs within a context of regulatory compliance, and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare...
Location:
Saint Paul, MN
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Board Certified
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Medical Director - Southeast Region

Humana
Louisville, KY
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Job Information Position Type: Full Time Certified Age-Friendly Become a ...
Details
Summary
About the job:
part of our caring community and help us put health first 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 an in-depth evaluation of variable factors. Job Profile 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...
Location:
Louisville, KY
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Board Certified
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Manager, Home Health Compliance

Humana
Kentucky
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Job Description Become a part of our caring community and help us put health ...
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About the job:
first The Manager, Compliance ensures compliance with governmental requirements. The Manager, Compliance works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals. The Manager, Compliance develops and implements compliance policies and procedures. Research compliance issues and recommends changes that assure compliance with contract obligations....
Location:
Kentucky
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Licensed Behavioral Health Utilization Management

Humana, Inc.
Indiana
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Become a part of our caring community and help us put health first The ...
Details
Summary
About the job:
Licensed Behavioral Health Utilization Management Professional 2 utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Licensed Behavioral Health Utilization Management Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Licensed Behavioral Health Utilization Management Professional 2 uses clinical...
Location:
Indiana
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
Certified Registered Nurse
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Accreditation Lead

Humana
Columbus, OH
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**Become a part of our caring community and help us put health ...
Details
Summary
About the job:
first**Responsible for leading all NCQA Health Equity Accreditation work for Humana's Medicaid markets. The ideal candidate will have a proven track record of success in accreditation and survey administration, as well as experience in leading teams and providing guidance on complex accreditation questions. They will work closely with cross-functional teams to ensure compliance with NCQA standards, manage team workload and work assignments, and play a key role in NCQA survey administration tasks. This is a dynamic role requiring...
Location:
Columbus, OH
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
High school diploma or equivalent
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
National Committee for Quality Assurance
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Medicare Grievances and Appeals Corporate Medical Director

Humana
Columbus, OH
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**Become a part of our caring community and help us put health first**The ...
Details
Summary
About the job:
Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The Corporate Medical Director works on problems of diverse scope and complexity ranging from moderate to substantial.The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana at Administrative Law Judge hearings. Exercises...
Location:
Columbus, OH
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Board Certified
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Medical Director - Mid West Region

Humana
Albany, NY
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Become a part of our caring community and help us put health first The ...
Details
Summary
About the job:
Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, level of care, and/or site of service should be authorized. All work occurs within a context of regulatory compliance, and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage...
Location:
Albany, NY
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Board Certified
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Licensed Behavioral Health Utilization Management

Humana
Indiana
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Job Information Job Category: Caregiving/ Healthcare Position Type: Full ...
Details
Summary
About the job:
Time Certified Age-Friendly Become a part of our caring community and help us put health first The Licensed Behavioral Health Utilization Management Professional 2 utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Licensed Behavioral Health Utilization Management Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate...
Location:
Indiana
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
Certified Registered Nurse
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Senior Care Management Support Professional - PDACS

Humana
Indiana
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Job Information Position Type: Full Time Certified Age-Friendly Become a ...
Details
Summary
About the job:
part of our caring community and help us put health first The Senior Care Management Support Professional (PDACS) supports the Participant-Directed Attendant Care Services process which empowers Members, or their representatives, to manage their own personal attendant care. - Engage and educate internal and external stakeholders about the concepts of PDACS and what is required to successfully develop and deliver service within the paradigm - Analyze, monitor and provide periodic reports on the utilization of PDACS....
Location:
Indiana
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Master's degree
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
Project Management Institute
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information
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