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Description The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments ..
Description The Care Management Support Assistant 3 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 ..
Job Information Humana Call Quality Professional 2 in San Juan Puerto Rico Description The Call Quality Professional 2 monitors and evaluates the quality of inbound and/or outbound customer service calls, call ..
Description The Supervisor, Inbound Contacts represents the company by addressing incoming telephone, digital, or written inquiries. The Supervisor, Inbound Contacts works within thorough, prescribed guidelines and procedures; uses independent judgment requiring ..
Description The Utilization Management Behavioral Health Professional 2 utilizes ... benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work ... of action. Responsibilities The Utilization Management Behavioral Health..
Job Information Humana Market Leadership Advisor (Managed/Health Care Industry) San Juan, PR in San Juan Puerto Rico Description The Market Leadership Advisor manages the development, operations, and results of a health ..
Description The Utilization Management Nurse 2 utilizes clinical nursing ... benefit administration determinations. The Utilization Management Nurse 2 work assignments are ... training and by leader. Utilization Management Nurse 2..
Description The Product Manager 2 Conceives of, develops, delivers, and manages products for customer use. The Product Manager 2 work assignments are varied and frequently require interpretation and independent determination of ..
Description The Wellness Coach 2 supports health promotion and disease prevention and care management services. The Wellness Coach 2 work assignments are varied and frequently require interpretation and independent determination of ..
Description The Project Manager 2 manages all aspects of a project, from start to finish, so that it is completed on time and within budget. The Project Manager 2 work assignments ..
Description The Supervisor, Grievances & Appeals manages client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. The Supervisor, Grievances & Appeals ..
Description The WEEKEND Pre-Authorization Behavioral Health Professional 2 reviews prior authorization requests for appropriate care and setting, follows guidelines and policies, and approves services or forwards requests as needed. The Pre-Authorization ..
... Care Managers, because our case management services are centered on the ... Previous adult chronic conditions care management. Previous experience in care management. Knowledge of complex care management and..
Job Information Humana Inbound Contacts Representative 2 (Fully Bilingual in English/Spanish) in San Juan Puerto Rico Description The Inbound Contacts Representative 2 represents the company by addressing incoming telephone, digital, or ..
... the organization. Prepares reports for management on the results of audits, ... their work, including performing project management functions for annual SOC-1 reporting. ... 5 years of audit, risk..
Description The Quality Assurance Technician develops and implements programs to establish and maintain quality standards of existing products and services, as well as developing programs to focus employees on the quality ..
Job Information Humana Call Quality Professional 1 (Bilingual English/Spanish) in San Juan Puerto Rico Description The Call Quality Professional 1 monitors and evaluates the quality of inbound and/or outbound customer service ..
Description Humana is looking for an experienced EAP Counselor that truly enjoys helping those in need within a call center environment. Our EAP Counselor's provide ongoing and crisis intervention counseling focused ..
Description The Manager, Care Management leads teams of nurses and ... health professionals responsible for care management. The Manager, Care Management works within specific guidelines and ... goals. Responsibilities The..
Description The Manager, Care Management leads teams of nurses and ... health professionals responsible for care management. The Manager, Care Management works within specific guidelines and ... Job Description The..
Description The Claims Processing Representative 3 reviews and adjudicates complex or specialty claims, submitted either via paper or electronically. The Claims Processing Representative 3 performs advanced administrative/operational/customer support duties that require ..
