- Humana (San Juan, PR)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … more
- Humana (San Juan, PR)
- …to adapt and the courage to innovate **Additional Information** Reports to the Lead Medical Director - North Central Medicaid Markets. The Medical ... caring community and help us put health first** The Medical Director relies on medical ...Medical Directors will learn North Central region state Medicaid requirements (currently VA, KY, OH, IN, WI) and… more
- Humana (San Juan, PR)
- …party reporting including notification, collection, analyze, storage, and distribution. + Team representative and presenter for various Medicaid committee ... caring community and help us put health first** The Associate Director , Procurement generates and implements efficient sourcing and category management strategies.… more
- Humana (San Juan, PR)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... and will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all submitted medical … more
- Humana (San Juan, PR)
- …home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether ... caring community and help us put health first** The Medical Director relies on fundamentals of CMS...consistency in outcomes, consumer experiences, and a highly engaged team culture + Knowledge and experience with national guidelines… more
- Humana (San Juan, PR)
- …home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether ... caring community and help us put health first** The Medical Director relies on fundamentals of CMS...consistency in outcomes, consumer experiences, and a highly engaged team culture** + **Knowledge and experience with national guidelines… more
- Evolent (San Juan, PR)
- …meaningful impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (San Juan, PR)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management ... team . We can offer you a meaningful way to...per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to… more
- Evolent (San Juan, PR)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a key member of the utilization management ... team . We can offer you a meaningful way to...timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to… more
- Evolent (San Juan, PR)
- …recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... will be a key member of the utilization management team . We can offer you a meaningful way to...Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests… more
- Humana (San Juan, PR)
- …to put those customers at the center of everything it does. The Director , Data Technology Solutions devises an effective strategy for executing and delivering on ... IT business initiatives. The Director , Data Technology Solutions requires an in-depth understanding of how organization capabilities interrelate across the function… more
- Humana (San Juan, PR)
- …of our caring community and help us put health first** The Associate Director , Business Intelligence solves complex business problems and issues using data from ... external sources to provide insight to decision-makers. The Associate Director , Business Intelligence requires a solid understanding of how...applications, and data resources. The role will lead a team of up to approx. 7-9 direct associates. **Key… more
- Baylor Scott & White Health (San Juan, PR)
- …dashboards and reports for senior leadership, hospital senior leadership, and senior medical staff including denials from all payers, Medicare/ Medicaid audit ... **Job Summary** The Director , Denial Resource Center is responsible for the..., Denial Resource Center will lead a highly skilled team of Registered Nurses, Certified Coding Specialists, Complex Appeal… more
- Humana (San Juan, PR)
- **Become a part of our caring community and help us put health first** Associate Director of Project Management to join the Readiness and Recovery team , focusing ... experiences, drive transformation, and support enterprise goals. The Associate Director will ensure alignment of project initiatives with business objectives,… more
- Humana (San Juan, PR)
- …part of our caring community and help us put health first** The Associate Director of DevOps Engineering is a strategic and technical leadership role responsible for ... guiding our DevOps initiatives. You will lead a team of talented DevOps engineers, focusing on standardization, building partnerships with software delivery teams to… more
- Humana (San Juan, PR)
- …of our caring community and help us put health first** The Associate Director of Project Management will support Product and Platform Enablement. This strategic ... platform capabilities and products that support enterprise goals. The Associate Director will ensure project alignment with business objectives, champion DevOps… more
- Humana (San Juan, PR)
- …community and help us put health first** Humana is seeking a forward-thinking Associate Director for Human Resources Technology to join our HRIT leadership team . ... meet end-user needs and strategic goals. + Lead a team of HRIT associates and contractors, driving a culture...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- Humana (San Juan, PR)
- …health first** The Senior Supply Chain Professional will report to the Associate Director of Enterprise Print Management and will be involved in the specifying, ... written and verbal communication skills + Ability to motivate project team members and stakeholders to meet established deadlines + Motivated initiative-taker… more