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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..
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 ..
... Manual (TRM), and the TRICARE Policy Manual (TPM). Assist with questions ... Electronic Questionnaire for Investigation Processing). Healthcare professional with a minimum of ... case management, clinics and/or other..
Job ID 21000GNRAvailable Openings 1Position Specific Information This position will cover the following clinics in the Springfield, Massachusetts area: Pioneer Valley Dialysis, Western Mass Kidney Center, East Springfield Dialysis, Palmer Dialysis, ..
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 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 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 ..
... 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 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 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 ..
... 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..
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 ..
... 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 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 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 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, ..
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 In order to make lasting, positive impact and change in the healthy equity of the communities we serve, leveraging the support of key stakeholders will be critical. As healthy equity ..
... 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..
... 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 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 ..
