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Description The Bilingual Grievances & Appeals Representative 3 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if an a grievance, appeal or further ..
Description . Responsibilities The Process Improvement Lead researches best business practices within and outside the organization to establish benchmark data. This individual collects and analyzes process data to initiate, develop and ..
Description The Supervisor, Grievances & Appeals manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if a grievance, appeal, or further request is warranted ..
Description The Behavioral Health Care Manager, in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness by guiding members/families toward resources appropriate for the ..
Description Are you someone who is passionate about helping Sales Agents learn through facilitation and development? Then we have a job for you! Humana is in search for our next Senior ..
... English and Spanish (see Additional Information below) Residency within the continental ... Word and MS Teams Additional Information Please be advised, any Humana ... protect member PHI / HIPAA..
Description The Subrogation Professional II identifies, investigates, and collects recoveries from third parties who are legally responsible for paying all or part of medical expenditures for an organization that provides health ..
... Enters and maintains pertinent clinical information in various medical management systems. ... guidelines. Experience in leadership. Additional Information While the normal operating hours ... as business needs dictate. Additional..
Description The Care Management Support Assistant contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness ..
Job Information Humana Telephonic Behavioral Health Care ... protect member PHI / HIPAA information. Additional information The department prefers candidates that ... working in the field. Additional information As part..
Description The Bilingual Grievances & Appeals Representative 3 manages client concerns by conducting and responding to complaints, grievances and appeals in a consistent fashion, adhering to all regulatory, accreditation and internal ..
Description The Senior Utilization Management Behavioral Health Professional utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Senior Utilization ..
Job Information Humana Bilingual Quality Auditor in ... Professional 2 Analyze Grievance/Appeals case information to ensure compliance of all ... Assessment in English/Spanish. See Additional Information on testing. Preferred Qualifications..
Description The Supervisor, Care Management Support contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness ..
Description The Enrollment Representative 3 processes applications from members, enrolls them on company platforms, and transmits enrollment to Center for Medicare and Medicaid Services. Responsibilities Data entry of member updates/provider changes ..
