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... health (BH)/Substance Use Disorder (SUD) clinical quality performance measures to achieve ... work closely with the Quality Director, Behavioral Health Director, Quality Improvement Manager and those ... Professional is..
Description The Medical Director relies on medical background and ... reviews health claims. The Medical Director work assignments involve moderately complex ... variable factors. Responsibilities The Medical Director actively uses..
Job Information Humana Nationwide Associate Director, Utilization Management Nursing in Charleston ... Charleston West Virginia Description The Associate Director, Utilization Management Nursing utilizes clinical nursing skills to support the .....
Job Information Humana Director, Informatics in Charleston West Virginia ... Charleston West Virginia Description The Director, Informatics coordinates with other analytics, ... insights from knowledge SMEs. The Director, Informatics requires..
Description Humana is seeking an experienced and dynamic Associate Director of Accreditation to manage a team of subject matter experts on NCQA Health Plan Accreditation and NCQA Health Equity Accreditation. The ..
... to the National Medicaid Quality Director, and be responsible for the ... in improving operational process and clinical care quality in an effort ... related issues, process improvement, and..
... Analytics is looking for an Associate Director of Data Science to lead ... future adverse health events. The Associate Director must be able to effectively ... business problems being..
... monthly records of clients’. Submits clinical paperwork to the office on ... Notify physical therapist or Executive Director of any equipment failures, lack ... performing patient care activities. Accept..
Description The Medical Director relies on fundamentals of CMS ... Line of Business. The Medical Director provides medical interpretation and determinations ... whether services provided by other healthcare professionals are..
Description The Director, Clinical Pharmacy Drug Evaluation and Policy ... Strategies oversees drug class reviews/evaluation, clinical policy strategy development, research, P&T ... manufacturers and providers. Responsibilities The Director, Clinical Pharmacy..
Description The Senior Product Manager role is a part of the Pharmacy Product & Growth organization and will be responsible for leading initiatives that help drive value for CenterWell Specialty Pharmacy. ..
Description The Medical Director actively uses their medical background, ... resources, which may include national clinical guidelines, CMS policies and determinations, ... guidelines, CMS policies and determinations, clinical reference materials,..
... 40) market leader in integrated healthcare with a clearly defined purpose ... experience and vitality of the associate community. Through offerings anchored in ... we are seeking an experienced..
Description The Behavioral Health Medical Director makes determinations regarding prior authorization ... resources which may include national clinical guidelines, Humana contract language, Humana ... and determinations, medical necessity criteria, clinical..
... The Lead Behavioral Health Medical Director oversees the work of 2 ... 2 Medical Directors who conduct clinical case reviews of the care ... The Lead Behavioral Health Medical..
Job Information Humana Director, Behavioral Health Strategy in Charleston ... Charleston West Virginia Description The Director, Behavioral Health (DBH) will ensure ... their behavioral health needs. The Director, Behavioral Health..
Description The Senior Pre-Authorization Nurse reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. Makes decisions on ..
