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The Clinical Consultant III provides clinical, technical, and product knowledge support to customers while building and maintaining solid relationships. Responsibilities include technical support during procedures, customer training, and collaboration with sales teams to identify new users for technology-enabled procedures.
The Utilization Review Nurse ensures high-quality, cost-efficient medical outcomes for enrollees needing inpatient/outpatient authorizations. Responsibilities include reviewing prior authorization requests, coordinating transitions of care, and managing health care within compliance regulations.
The Care Transitions Nurse facilitates a proactive partnership with patients to manage their health-related needs. They assess, plan, coordinate, and evaluate services to empower individuals and their families in accessing resources and adopting healthy lifestyles.
The Nurse Practitioner will perform comprehensive care using advanced health assessment and therapeutic management for patients with addictions and co-existing health conditions. They will provide recovery-oriented, trauma-informed care and act as a resource for clinical advice related to substance use.
Provide online treatment and ongoing care for patients with a focus on weight management. Utilize the Felix platform to deliver healthcare services remotely.
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EAP Counsellors provide telephonic and video counselling, offering in-the-moment support and crisis management. They assess clients for appropriateness for short-term counselling and develop treatment plans while maintaining client confidentiality.
The Health Educator Associate assists professional staff by developing, conducting, and delivering health education interventions. This role promotes, maintains, and improves individual and community health by helping individuals and communities adopt healthy behaviors.
The RN Clinical Review Nurse performs concurrent reviews to evaluate the necessity and appropriateness of care being delivered to members. This includes collaborating with healthcare providers and contributing to discharge planning according to established guidelines.
Analyze intake assessments and conduct diet and lifestyle counseling sessions via video. Collaborate with medical professionals and maintain accurate patient records.
Analyze intake assessments and conduct diet and lifestyle counseling sessions via video. Collaborate with medical professionals and maintain accurate patient records.
Analyze intake assessments and conduct diet and lifestyle counseling sessions via video. Collaborate with medical professionals and maintain accurate patient records.
Analyze intake assessments and conduct diet and lifestyle counseling sessions via video. Collaborate with medical professionals and maintain accurate patient records.
Analyze intake assessments and conduct diet and lifestyle counseling sessions via video. Collaborate with medical professionals and maintain accurate patient records.
Analyze intake assessments and conduct diet and lifestyle counseling sessions via video. Collaborate with medical professionals and maintain accurate patient records.
Analyze intake assessments and conduct diet and lifestyle counseling sessions via video. Collaborate with medical professionals and maintain accurate patient records.
Independently assess and recommend actions on trust and safety concerns while mitigating organizational risk. Collaborate with cross-functional teams and manage sensitive information to uphold marketplace standards.
Manage, validate, and analyze large health insurance claims datasets using appropriate statistical methods. Work closely with interdisciplinary investigators to contribute to academic manuscripts and written reports.
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The Social Worker serves as an advocate for claimants, providing access to community services and developing programs to improve patient care. They handle complex issues, provide emotional support, and maintain accurate records of client interactions.
As an Intake Coordinator - Clinical, you will be responsible for the timely and accurate entry of home health referrals and communication with care center and business development staff. You will also utilize clinician’s state license to obtain orders for admissions when appropriate.
The clinician serves as a clinical co-manager on behavioral health claims, providing expertise in analyzing clinical information and negotiating return-to-work plans. They also review and evaluate disability claims to determine the level of functioning based on behavioral health conditions.
The Manager of Clinical Services and Operations provides operational leadership for clinical teams, ensuring high-quality and compliant care. This role involves overseeing program implementation, monitoring KPIs, and driving continuous improvement initiatives.
The Pharmacy Contracting Professional 2 ensures all published materials support the contracting process and may perform analysis regarding pharmacy claims and purchasing data. They draft communications for stakeholder review and coordinate with various departments to publish communications.
The Senior Pharmacy Contracting Professional conducts all aspects of pharmaceutical contracting and pricing, including development, implementation, and maintenance. They oversee relationships with Humana pharmacy partners and support pharmacies throughout the contracting process.
The Clinical Document Integrity Specialist will review inpatient medical records for completeness and accuracy, ensuring effective communication with healthcare providers to suggest necessary documentation improvements. They will collaborate with various healthcare professionals to facilitate accurate documentation that reflects the patient's clinical status.
The Teletherapist will provide therapy through a HIPAA compliant teletherapy platform in standard 45-60 minute sessions. Responsibilities include completing assessments, treatment plans, and progress notes while providing input on strategies to help clients.
Conduct thorough patient assessments and develop personalized treatment plans via video visits. Collaborate with a multidisciplinary team to deliver the highest standards of care.
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Conduct thorough patient assessments and develop personalized treatment plans via video visits. Collaborate with a multidisciplinary team to deliver the highest standards of care.
The role involves responding to medical and safety-related inquiries from healthcare professionals and patients, using approved product information to provide accurate responses. Additionally, the specialist will document adverse events and support service quality through checks and training of new team members.
The APP works remotely to manage provider in-basket folders, including patient messages and urgent refills. They collaborate with MA and nursing staff to ensure patient care and coverage during provider absences.
The Nurse Practitioner will work directly with patients in a structured, fully remote environment, supporting recovery in alignment with harm reduction principles. They will be responsible for prescribing buprenorphine-based medications and initiating care as part of their daily practice.
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