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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 Responsibilities The Associate Director for ACD Audit , at the director of the Director of Payment Integrity, will create and implement process improvement plans focused on the beneficiary and provider ..
Description The Supervisor, Consultative Pharmacy Technicians certified Pharmacy Technician who acts as an intake for all calls from patients, pharmacies and providers. The Supervisor, Consultative Pharmacy Technicians works within thorough, prescribed ..
Description The Associate Director, Problem, Incident and Event Management drives technical support teams to recover services during periods of service disruption or outages to key technology platforms/applications. The Associate Director, Problem, ..
... 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..
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 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 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 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 ..
... 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..
... with contract and complex ACD policy requirements as defined by the ... Demonstrates understanding of the ACD policy requirements and Program Integrity policies, ... to operationalize this very complex..
Description The Behavioral Health Parity Compliance Lead will play an integral role in the oversight and management of our Mental Health Parity Compliance Program. Responsibilities This role is responsible for monitoring ..
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 ..
... 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..
... 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 ..
... (ECM) team needs your business, healthcare and research acumen to solve ... acumen to solve for the healthcare challenges of today. The Clinical ... and clinical issues using our..
... 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..
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 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 Director, Strategy Advancement provides data-based strategic direction identifying and delivering new avenues of growth is a critical company priority, championed by the SVP of Retail Strategy & Product. We're ..
