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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 ..
Job Information Humana Quality Audit Professional 2 (Grievance & Appeals) -(FULLY BILINGUAL English/Spanish) Remote, anywhere with-in Eastern Time Zone in Portland Maine Description The Quality (Non-Calls) Professional 2 ensures that products ..
Description The Grievances & Appeals Representative 4 manages client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. The Grievances & Appeals ..
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..
... 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 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 ..
Description The Bilingual Manager, Learning Facilitation , plans, coordinates, and implements all aspects of training programs for participants throughout for Grievance and Appeals / Careplus. EST states Responsibilities The Bilingual Grievances ..
Job Information Humana Medical Claims Processing Representative 2 in Portland Maine Description The Medical Claims Processing Representative 2 reviews and adjudicates complex or specialty claims, submitted either via paper or electronically. ..
Description Full-Time Remote, Telephonic RN opportunity. The Utilization Management Behavioral Health Nurse utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services. Enjoy the flexibility ..
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 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 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 ..
Description The Care Manager, Telephonic Nurse 2, in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate ..
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 Are you passionate about contributing to the well-being of the Medicare population? Are you looking for a role that will let your creative ideas, relationship management and sales ability shine? ..
... strategy by collecting broad based information and gathering resources and data ... corrected facility, MD, and diagnosis information Ensure members are picked up ... protect member PHI / HIPAA..
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 Responsibilities Humana's Corporate Marketing organization is seeking 2 Bilingual Production Professionals that are fluent in both English and Spanish to join the Humana Translation team supporting Medicaid growth and to ..
Description Healthcare isn't just about health anymore. It's about caring for family, friends, finances, and personal life goals. It's about living life fully. At Humana, we want to help people everywhere, ..
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 ..
... 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 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 ..
