8 family medicine jobs found

Become a part of our caring community and help us put health first The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting medical necessity and comprehensive medication reviews for prescriptions requiring prior authorization. This role involves evaluating complex clinical scenarios and applying evidence-based criteria to ensure appropriate medication use. The pharmacist addresses moderately complex to complex issues that require critical thinking and in-depth analysis of variable factors. Earn a $5,000 hiring bonus! Bonus is paid after 180 days of employment; you must be employed until that date to be eligible to receive the payment." Location: Remote - United States Schedule: 8-hour shifts, Monday through Friday, between 10:30 AM and 11:00 PM EST OR 10-hour shifts, Tuesday through Friday, between 10:30 AM and 11:00 PM EST Required to work every 5th Saturday Required to work 1 company holiday...

Become a part of our caring community and help us put health first The Risk Management Professional 2 identifies and analyzes potential sources of loss to minimize risk. The Risk Management Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines and procedures. As a Risk Management Professional 2 - HCPR Compliance, you will work with HCPR Operations to ensure operational processes are complaint with appropriate regulations and report data that accurately reflects operations. In this role you will: In this role you will: Develop data universe generation guidelines (DUGG) for audit universes by interpreting protocols/guidance and reconciling it to processes/system logic Produce monthly...

Become a part of our caring community and help us put health first Encounter Data Management Professional is responsible for ensuring accurate submission and reconciliation of encounter data to Medicaid and Medicare through effective business processes. Ensures claims submissions meet or exceed all compliance standards via analysis of data and develops tools to enhance the encounter acceptance rate by Medicaid/Medicare. Looks for long-term improvements of claims submission processes. Takes ownership by applying professional standards, regulations, and strategies within their work area. Independently sets priorities and makes decisions on work approach while following established direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation. Humana's Encounter Data Management (EDM) team is seeking an Encounter Data Management Professional that has experience with business processing and data...

Become a part of our caring community and help us put health first With over 10 million sales interactions annually, Humana understands that while great products are important, it's the quality of our service that truly defines us. We know that when our members and prospects have delightful and memorable experiences, it strengthens their connection with us and enables us to put their Health First. After all, a health services company that has multiple ways to improve the lives of its customers is uniquely positioned to put those customers at the center of everything it does. IFG is a subsidiary of Humana The Senior Organization Effectiveness Professional optimizes the effectiveness of a company, business unit, or team. Analyze the internal structure of the organization and create strategies to maximize employee work output and effectively utilize employee skills. The Senior Organization Effectiveness Professional work assignments involve moderately complex to complex...

Become a part of our caring community and help us put health first The Principal Product Manager Conceives of, develops, delivers, and manages products for customer use. The Principal Product Manager provides strategic advice and guidance to functional team(s). Highly skilled with broad, advanced technical experience. A high-performing, independent role dedicated to tackling cross-team, cross-functional technology and analytics problems in with a focus on innovation, action, and speed-to-market. Primary focus will be on ensuring complete and accurate diagnosis and follow up for our members. This role will work with 2-5 developers within our team on high-profile projects. Responsibilities will include partnering with the business, gathering requirements, developing project plan including resource needs, supervising project execution, hands-on development and analysis as appropriate, customer feedback loop, executive presentation. Critical skills include independent project...

Become a part of our caring community and help us put health first At Humana, we are focused on the elimination of unjust, avoidable and unnecessary barriers in health and health care. The Data Manager 2 (DM2), reporting to the Health Equity Strategy Lead, supports the whole-person, integrated care model for members in our Medicaid and Medicare market to help build the toolkit for equitable population health. In particular, we partner with executives, managers and other leads to advance Care Management, Quality Improvement, Community Engagement, Marketing, Health Economics and Finance to bring a greater understanding of factors that apply to wellbeing from a view of physical, behavioral and spiritual health. The Data Manager 2 supports all aspects of configuration control, data management, and deficiency reporting. The Data Manager 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action....

Become a part of our caring community and help us put health first The Customer Success Manager is a key leadership role responsible for ensuring customer retention through proactive engagement, strategic initiatives, and operational excellence. This role works collaboratively to ensure alignment and consistent performance, managing up to 25 Customer Success Agents to deliver on retention objectives and test new business initiatives. The Customer Success Manager plays a critical role in driving customer retention through proactive engagement with customers and the implementation of strategic retention initiatives. In addition to core retention campaigns and allegation mitigation, the role supports Call Quality for their team, contributes to broader enterprise value by test & learning new initiatives, and can be part of building something from the ground up. The Customer Success Manager should be ready to receive objectives and determine approach, resources, goals, and...

Become a part of our caring community and help us put health first The Manager, Fraud and Waste conducts investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals. Where You Come In The Manager, Fraud and Waste coordinates investigation with law enforcement authorities. Assembles evidence and documentation to support successful adjudication, where appropriate. Conducts on-site audits of provider records ensuring appropriateness of billing practices. Prepares complex investigative and audit reports. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and...