Healthcare Performance Improvement Jobs

Description The Senior Stars Clinical Professional (RN) works through phone calls and other outreach methods with members, providers, and/or vendors to close HEDIS care gaps. The Senior Stars Clinical Professional work ..

Description The Senior Stars Improvement, Clinical Professional responsible for the ... Stars Program. The Senior Stars Improvement, Clinical Professional work assignments involve ... factors. Responsibilities The Senior Stars Improvement, Clinical..

... all areas impacting DCE operations, performance, experience, and outcomes including provider ... as they relate to provider performance, beneficiary experience, DCE growth, provider ... engagement strategy, identifying and implementing..

... concurrent reviews to identify documentation improvement opportunities according to CMS and ... for diagnosis code selection Educate healthcare provider, coder and/or office staff ... long-term, self-sustaining solution for the..

Description The Director, QOCA Strategy - serves as the strategic leader in resource utilization; budget and MER oversight; vendor oversight; and for clinician and non-clinician flex associates and off-shore vendor associates ..

Description The Pharmacy Clinical Advisor Professional 2 is an integral part of the Pharmacy Stars team which is accountable for Humana's Patient Safety and medication related Star measure performance. The Pharmacy ..

... 41) market leader in integrated healthcare with a clearly defined purpose ... we are seeking an experienced healthcare leader to join our team ... President, Strategy Advancement for our..

... relationships with physicians, providers and healthcare systems in order to support ... and improve financial and quality performance within the contracted working relationship ... across such areas as financial..

Description The Senior Process Improvement Professional analyzes, and measures the ... process improvements. The Senior Process Improvement Professional work assignments involve moderately ... well as other HCS Business Improvement, Technology,..

Description As Lead Actuary of the Risk Predictive Models team, you have an opportunity to both learn more about predictive analytics and machine learning and to see it become very real ..

Description Be a part of an interactive team with broad exposure and scope within Humana. Humana is seeking a positive and proactive individual to contribute to a high performing team that ..

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 The Process Improvement Professional 2 analyzes, and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Process Improvement Professional 2 work assignments ..

Job Information Humana Medicaid Associate Director, Compliance Nursing in Colorado Springs Colorado Description The Associate Director, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and ..

Description The Pre-Authorization Behavioral Health Professional 2 reviews prior authorization requests for appropriate care and setting, follows guidelines and policies, and approves services or forwards requests as needed. The Pre-Authorization Behavioral ..

... through TRICARE and other military healthcare programs. High-quality service, cost-effective platforms, ... Ensure adherence to policies and performance standards in accordance with the ... participate in Care Management quality..

... through TRICARE and other military healthcare programs. High-quality service, cost-effective platforms, ... Ensure adherence to policies and performance standards in accordance with the ... participate in Care Management quality..

Description Responsibilities This position will maintain the Humana Military ACD website Autism Center of Excellence (CoE); ensuring educational information is current and relevant to training needs in addition to analyzing and ..

... the ability look at provider performance metrics and be able identify ... available resources Performs analysis of performance indicators and puts together a ... with providers to participate in..

... through TRICARE and other military healthcare programs. High-quality service, cost-effective platforms, ... Ensure adherence to policies and performance standards in accordance with the ... participate in Care Management quality..

... matter expertise on all Quality Improvement Department data sources and report ... to management Work with Quality Improvement team members to create a ... department Gain feedback for service..

... that our members receive quality healthcare at an affordable price. You ... recommendations Identify and suggest process improvement opportunities Develop and monitor team ... and coaching, and conduct annual..

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 ..