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Job Information Humana Healthcare Lead Product Manager: Chinese and Korean Segment Medicare Advantage in Cincinnati Ohio Description The Lead Product Manager Conceives of, develops, delivers, and manages products for Chinese and ..
Job Information Humana Clinical Recruiter 2 - VSP in Cincinnati Ohio Description The Clinical Recruiter 2 interviews prospective employees for hourly and salaried positions. Assists with Pharmacy recruiting from entry level ..
Job Information Humana Medicaid Associate Director, Compliance Nursing in Cincinnati Ohio Description The Associate Director, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations ..
Description Humana Special Needs Plans provide personalized guidance and resources to help members get the right care and information based on their specific condition or needs. Beneficiaries qualify with the following ..
Description Responsibilities The Utilization Management Nurse 2 will be responsible for performing clinical audits on medical record documentation for quality and clinical compliance with contract requirements as outlined in the Autism ..
... Medicaid Quality Data and Reporting Analyst generates ad hoc reports and ... Medicaid Quality Data and Reporting Analyst will be responsible for the ... Qualifications: Bachelor's degree in Business,..
Description Responsibilities The Care Manager, Behavioral Health 2 (BCBA) is responsible for the administration and monitoring of the Autism Care Demonstration (ACD) including coordination of services for ABA Therapy, benefits provided ..
Job Information Humana Sr. Clinical Recruiter - VSP( Variable Staffing Pool) in Cincinnati Ohio Description The Senior Recruiter interviews prospective employees for hourly and salaried positions. Assists with university graduate and ..
... Program Evaluation. Improve quality measure performance through innovative approaches in engaging ... Analyze dashboards consisting of Key Performance Indicators (KPI), and non-KPI metrics, ... by the National Association for..
Description The Senior Claims Research & Resolution Professional manages claims operations that involve customer contact, investigation, and settlement of claims for and against the organization. Approves all claims issues/complaints within contractual ..
Description Responsibilities The Care Management Support Assistant 2- ACD Referral Coordinator-will process referrals from Military Treatment Facilities (MTFs) and civilian providers for the ACD program. The ACD Referral Coordinator performs varied ..
Description The Principal Quality Leader will lead testing and quality collaboration between Business and IT, guiding test strategies and tools and assure adherence to quality standards. Serves as point of contact ..
Description Responsibilities The Consumer Service Operations Professional 2 evaluates claims oversight performance metrics by interfacing with the sub-contractor to gather and track associated reporting. The Consumer Service Operations Professional 2 evaluates ..
Description The Dental Director (part-time) provides dental interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Responsibilities The ..
... Oversight will: monitor the clinical performance of the third party vendor ... oversight including quality, compliance and performance experience Experience in managed care ... field Previous experience managing program..
Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires ..
Description The Senior Value-Based Financial Analyst supports successful value-based provider relationships ... Responsibilities The Senior Value-Based Financial Analyst advises executives to develop functional ... Qualifications Bachelor's degree in Business, Healthcare,..
... and medication related Star measure performance. The Pharmacy Clinical Advisor Professional ... with metrics reporting and program performance including ROI analyses. Taking action ... with key partners and data..
... for ensuring the investment and performance are consistent with customer needs. ... to provide Humana with product performance, reduced trend and growth. Serve ... insights Bachelor's degree in Business,..
... 60 market leader in integrated healthcare with a clearly defined purpose ... us redefine the future of healthcare. With a history of transformation ... about solving big problems in..
Description The Provider Contracting Executive initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Provider Contracting Executive works on problems ..
Description The Sr. Consumer Experience Professional performs data analysis supporting learning plans via management and usage of consumer behavioral, demographic, and attitudinal data. The Sr. Consumer Experience Professional work assignments involve ..
