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1 - 10 of 243 matches in 0.01 seconds
Senior Full Stack Software Engineer - Member Administration (JC185416392)
Last Updated: 2021-06-09
Employer: Humana
Location: Chicago, IL

Description

Humana is rapidly evolving from an insurance company with elements of health to a healthcare company with elements of insurance. We are embarking on an ambitious journey to implement a new Member Administration Platform and further our evolution towards a customer-centric operating model. As a member of the Member…

Medical Director (JC185416595)
Last Updated: 2021-06-09
Employer: Humana
Location: Chicago, IL

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 situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Medical Director actively uses their medical background, experience, and judgement to…

Claims Analyst (JC185397496)
Last Updated: 2021-06-09
Employer: Centene Corporation
Location: Burr Ridge, IL

Position Purpose:

Process pended medical claims, verifying and updating information on submitted claims and reviewing work processes to determine reimbursement eligibility. Ensure payments and/or denials are made in accordance with company practices and procedures.

+ Apply policy and provider contract provisions to determine if claim is payable, if additional information…

Compliance Analyst (JC185397500)
Last Updated: 2021-06-09
Employer: Centene Corporation
Location: Chicago, IL

Position Purpose :

+ Assist in maintaining Centene Corporation’s Compliance Program; guide special projects; provide regulatory interpretation; perform compliance reporting; and develop and implement compliance auditing and monitoring strategies.

+ Respond to external requests for information required by the organization for its regulatory filings.

+ Respond to inquiries from state…

Program Coordinator I (JC185397536)
Last Updated: 2021-06-09
Employer: Centene Corporation
Location: Burr Ridge, IL

Position Purpose:

Assist in activities related to the medical and psychosocial aspects of utilization and coordinated care.

+ Initiate authorization requests for output or input services in keeping with the prior authorization list. Research claims inquiry specific to the department and responsibility.

+ Perform tasks necessary to promote member compliance…

Program Specialist I - Social Work (JC185397594)
Last Updated: 2021-06-09
Employer: Centene Corporation
Location: Burr Ridge, IL

Position Purpose:

+ Identify special needs members through the completion of health screens and other resources

+ Work with community outreach/member advocates to coordinate member care

+ Educate providers and community resources on program components and available support services

+ Educate members with special needs to foster compliance with program…

Inbound Contacts Representative 1 (Work at Home) (JC185416062)
Last Updated: 2021-06-09
Employer: Humana
Location: Chicago, IL

Description

The Inbound Contacts Representative 1 (Go365 Calls Rep) represents the company by addressing incoming telephone, digital, or written inquiries. The Inbound Contacts Representative 1 performs operational/customer support/computational tasks. Typically works on routine and patterned assignments.

Responsibilities

Be a part of Humana Go365 Service Operations – As an Inbound Contacts…

HPS Clinical Drug Policy Management - Senior Operations Prof (JC185416425)
Last Updated: 2021-06-09
Employer: Humana
Location: Chicago, IL

Description

The Senior Clinical Drug Policy Management Professional provides clinical and operational leadership for the creation and maintenance of clinical tools which help facilitate clinical medication review decision. The Senior Clinical Drug Policy Management Professional work assignments involve moderately complex to complex issues where the analysis of situations or data…

Manager, Medical Management Operations (JC185397568)
Last Updated: 2021-06-09
Employer: Centene Corporation
Location: Illinois, IL

Position Purpose:

+ Evaluate existing medical management practices for assigned business unit

+ Evaluate and resolve inefficiencies; identify and drive process improvement opportunities

+ Utilize continuous process improvement techniques to explore approaches to work processes to eliminate waste and ensure resources are allocated to high value activity

+ Adopt and…

Long Term Support Services Care Specialist-Peoria County (JC185397569)
Last Updated: 2021-06-09
Employer: Centene Corporation
Location: Peoria, IL

Position Purpose:

Oversees the care for long term support services / long term care populations and provides coordination of care services for lower acuity individuals living in the community or nursing facilities. Ensures a comprehensive assessment of member’s care needs and status, interdisciplinary team approach, and education of members. Works…

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