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Senior Accreditation Professional

Humana
Columbus, OH
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**Become a part of our caring community and help us put health first**We are ...
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Summary
About the job:
seeking a Senior Accreditation Professional who will work in a team environment on Humana's health plan accreditations, performing complex tasks related to compliance with accreditation standards across multiple operational areas within Humana.**Role Responsibilities:**+ Serves as subject matter expert on NCQA Health Plan Accreditation Long-Term Services and Supports (LTSS) requirements, advising stakeholders on compliance, and facilitating NCQA LTSS file universe preparation and LTSS file reviews.+ Works closely...
Location:
Columbus, OH
Job Type:
Full-Time
Permanent
Occupation:
Business Operations Specialists, All Other
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
National Committee for Quality Assurance
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Medical Director - North Central Region - Medicaid

Humana
Saint Paul, MN
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**Become a part of our caring community and help us put health first**The ...
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About the job:
Medical Director relies on medical background and reviews health claims. The Medical Director (Staff Geriatrician or Physician with Ten (10) Years of Clinical Practice with Older Adults) works assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.The Staff Geriatrician or Physician with Ten (10) Years of Clinical Practice with Older Adults (Medical Director) is dedicated full time to the Indiana Pathways program to assist the...
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

RN - Nursing Educator 2 (UM, CM, Pre-Certs, Compliance) - Remote

Humana
Saint Paul, MN
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**Become a part of our caring community and help us put health first**The ...
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About the job:
RN, Nursing Educator 2 plans, directs, coordinates, evaluates, develops, delivers training and education programs for professional nursing personnel. The RN, Nursing Educator 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.The RN, Nursing Educator 2 develops educational goals and plans for new associate orientation, ongoing training, and professional development. Training programs may include, but not be limited to, Pre-Certification,...
Location:
Saint Paul, MN
Job Type:
Full-Time
Permanent
Occupation:
Health Education Specialists
Career Level / Education:
Associate's degree
Salary:
Upper Middle Income Jobs ($50K-$79K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
5
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Referrals Coordinator

Humana
Saint Paul, MN
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**Become a part of our caring community and help us put health first**The ...
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About the job:
Referrals Coordinator 2 processes referrals from Military Treatment Facilities (MTFs) and civilian providers. The Referrals Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.The **Referrals Coordinator 2** handles some inbound calls, performs data entry into the medical management system, assigning an appropriate provider, reviewing for benefits, and/or medical necessity as required...
Location:
Saint Paul, MN
Job Type:
Full-Time
Permanent
Occupation:
Medical Secretaries and Administrative Assistants
Career Level / Education:
High school diploma or equivalent
Salary:
Middle Income Jobs ($30K-$49K)
Certifications / Licenses:
Security clearance
Workkeys
Applied Math
3
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Utilization Behavioral Health Professional

Humana
Saint Paul, MN
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**Become a part of our caring community and help us put health first**Humana ...
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Summary
About the job:
Healthy Horizons is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.You will be part of a caring community at Humana.When you meet...
Location:
Saint Paul, MN
Job Type:
Full-Time
Permanent
Occupation:
Mental Health and Substance Abuse Social Workers
Career Level / Education:
Master's degree
Salary:
Upper Middle Income Jobs ($50K-$79K)
Certifications / Licenses:
Licensed Master Social Worker
Licensed Clinical Social Worker
Licensed Professional Counselor
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information

Utilization Management Administration Coordinator

Humana
Cincinnati, OH
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**Become a part of our caring community and help us put health first**Humana ...
Details
Summary
About the job:
Healthy Horizons in Ohio is seeking a Utilization Management Administration Coordinator 2 who contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.You will be part of a caring community at Humana. When you meet us, you can tell we started as a hometown company. We are proud of our Louisville roots and, as...
Location:
Cincinnati, OH
Job Type:
Full-Time
Permanent
Occupation:
Medical Secretaries and Administrative Assistants
Career Level / Education:
Bachelor's degree
Salary:
Upper Middle Income Jobs ($50K-$79K)
Certifications / Licenses:
ICD-10 / ICD-9
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Medical Director - North Central Region - Medicaid

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 relies on medical background and reviews health claims. The Medical Director (Staff Geriatrician or Physician with Ten (10) Years of Clinical Practice with Older Adults) works assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.The Staff Geriatrician or Physician with Ten (10) Years of Clinical Practice with Older Adults (Medical Director) is dedicated full time to the Indiana Pathways program to assist the...
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

Referrals Coordinator

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:
Referrals Coordinator 2 processes referrals from Military Treatment Facilities (MTFs) and civilian providers. The Referrals Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.The **Referrals Coordinator 2** handles some inbound calls, performs data entry into the medical management system, assigning an appropriate provider, reviewing for benefits, and/or medical necessity as required...
Location:
Columbus, OH
Job Type:
Full-Time
Permanent
Occupation:
Medical Secretaries and Administrative Assistants
Career Level / Education:
High school diploma or equivalent
Salary:
Middle Income Jobs ($30K-$49K)
Certifications / Licenses:
Security clearance
Workkeys
Applied Math
3
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

UM Administration Coordinator

Humana
Columbus, OH
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**Become a part of our caring community and help us put health first**Humana ...
Details
Summary
About the job:
Healthy Horizons in Ohio is seeking a Utilization Management Administration Coordinator 2 who contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.You will be part of a caring community at Humana. When you meet us, you can tell we started as a hometown company. We are proud of our Louisville roots and, as...
Location:
Columbus, OH
Job Type:
Full-Time
Permanent
Occupation:
Medical Secretaries and Administrative Assistants
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
Certifications / Licenses:
ICD-10 / ICD-9
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information

Utilization Behavioral Health Professional

Humana
Columbus, OH
Actions
Apply
Save to My Profile
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**Become a part of our caring community and help us put health first**Humana ...
Details
Summary
About the job:
Healthy Horizons is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.You will be part of a caring community at Humana.When you meet...
Location:
Columbus, OH
Job Type:
Full-Time
Permanent
Occupation:
Mental Health and Substance Abuse Social Workers
Career Level / Education:
Master's degree
Salary:
Upper Middle Income Jobs ($50K-$79K)
Certifications / Licenses:
Licensed Master Social Worker
Licensed Clinical Social Worker
Licensed Professional Counselor
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information
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