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Description The Senior Policy Governance Professional policy Governance is the combination of ... toward achieving goals. The Senior Policy Governance Professional work assignments involve ... variable factors. Responsibilities The Senior..
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Description The Supervisor, Inbound Contacts represents the company by addressing incoming telephone, digital, or written inquiries. The Supervisor, Inbound Contacts works within thorough, prescribed guidelines and procedures; uses independent judgment requiring ..
Description The Senior Demand and Portfolio Management Professional collaborates with the business portfolio team to align the IT portfolio and demand. The Senior Demand and Portfolio Management Professional work assignments involve ..
... completed as required by ACD policy; administer &/or collect outcome measures ... measures as defined by ACD policy, provide outcome measure data to ... behavioral health, and/or ASD; a..
... relationships with physicians, providers and healthcare systems in order to support ... relationships with physicians, providers and healthcare systems in order to support ... Required Qualifications Bachelor's Degree in..
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 ..
... Review ABA treatment plans for policy compliance. Assist with analysis of ... States with a focus upon policy and utilization management Participate in ... with Clinical Department and Program..
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 The Staff Utilization Management Pharmacist is a clinical pharmacist who completes medical necessity and comprehensive medication reviews for prescriptions requiring pre-authorization. The Staff Utilization Management Pharmacist work assignments involve moderately ..
Description Responsibilities The Compliance Professional 2 has responsibilities for performing clinical audits on medical record documentation for quality and clinical compliance with contract requirements as outlined in the Autism Care Demonstration ..
... Bachelor's degree 4 years of healthcare experience Strong consultative and relationship ... Masters in Business, Finance or Healthcare Administration Six Sigma or PMP ... with the Tobacco Free Hiring..
Job Information Humana Medicaid Associate Director, Compliance Nursing in Albuquerque New Mexico Description The Associate Director, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and ..
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 ..
... etc. Requires understanding of Tricare policy on Autism Care Demonstration. Decisions ... are focused on ACD department policy and methods for completing assignments. ... Processing) . Two years prior..
Description The Senior Stars Improvement, Clinical Professional develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve quality performance. The Senior Stars Improvement, ..
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 ..
Description The Pharmacy Claims Lead operationalizes and monitors Coordination of Benefits (COB) and subrogation claim processing logic and processes. Exercises independent judgment and decision making on managing staff, complex issues regarding ..
Description The Senior Compliance Professional ensures compliance with governmental requirements. The Senior Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an ..
Description The Pre-Authorization Nurse 2 reviews Genetic testing prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The ..
Description The Senior Clinical Strategy and Practice Professional builds strategies for development, engagement, best clinical practices and processes for clinical community within the enterprise The Senior Clinical Strategy and Practice Professional ..
... acumen to solve for the healthcare challenges of today. The Clinical ... years or more working in healthcare or a related industry 3 ... in business or public health..
