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Medical Director - Southeast Region - Work from Home at Humana in Boise, Idaho, United States Job Description Become a part of our caring community and help us put health first The Medical Director relies on medical background and reviews health claims.
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The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease or care management.
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Medical Directors support Humana values, and Humana's Bold Goal mission, throughout all activities. Supports the assigned work with respect to market-wide objectives (e.g. Bold Goal) and community relations as directed.
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Experience with national guidelines such as MCG or InterQual + Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specialization + Advanced degree such as an MBA, MHA, or MPH + Exposure to Public Health principles, Population Health, analytics, and use of business metrics.
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Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope. May also engage in grievance and appeals reviews.
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The clinical scenarios predominantly arise from inpatient or post-acute care environments. About us Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company.
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Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post-acute services (such as inpatient rehabilitation.
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Preferred Qualifications + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.
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Take initiative to help participants be part of the community and enjoy their favorite activities. As a Caregiver / Direct Support Professional ( DSP ), you’ll provide assistance and strategies to the individuals we serve to help them live well in their community and environment.
$15 - $17 an hourFull-timeRemoteExpandUpdated Today - UpvoteDownvoteShare Job
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Additional activities include: learning and staying informed on the complex and comprehensive Research & Learning product line; learning and following a comprehensive sales process; updating and managing sales pipeline information for an assigned list of accounts; managing time and resources effectively; representing Wolters Kluwer within the industry and territory; and contributing to sales planning and forecasting activities.
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For Ohio and Florida onlyActive and unrestricted Community Health Worker (CHW) Certification. Current Community Health Worker (CHW) Certification preferred (for states other than Ohio and Florida, where it is required.
Starting at $14.76 - $31.97 an hour depends on education, experienceFull-timeRemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives; Organizes or schedules other people and their tasks; Develops realistic action plans.
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Assists Pharmacy Manager and Staff Pharmacist in developing and maintaining good relationships with the local medical community, including physicians, nurses, and other health care providers, by medical provider detailing and outreach to health groups, retirement homes, nursing homes, and other forums for enhancing growth opportunities.
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Provides guidance and support to department and OVPRS-RA financial administrators in support of grant administration activities. Assists the Associate Vice President with the operational and strategic implementation of systems, processes, change management, and training activities for both intra-office and institutional programs/activities.
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As a member of a multidisciplinary team, the Nurse Reviewer II is responsible for assessing, planning, organizing, reviewing and evaluating the care needs of Members requiring community based services.
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