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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 Account Management Financial Analyst analyzes and forecasts financial, economic, ... and operational decisions. This Financial Analyst work assignments are varied and ... Analytics team. Responsibilities The Financial Analyst..
Description The Financial (Pricing) Analyst analyzes and forecasts financial, economic, ... and operational decisions. This Financial Analyst work assignments are varied and ... Analytics team. Responsibilities The Financial Analyst 2..
Description Responsibilities This role within the Autism Care Demonstration (ACD) Team, will work closely with Care Management leaders and Subject Matter Experts in the areas of Case Management, Utilization Management and ..
... by the National Association for Healthcare Quality (NAHQ), Certified QI Associate ... public health, health administration, health policy or business. Minimum five (5) ... Quality Improvement/Quality Assurance in the..
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 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 ..
... 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 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 ..
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 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, ..
... 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 Staff Clinical Pharmacist- Clinical Formulary Administration monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders. Utilizes broad understanding of managed care and PBM knowledge ..
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 ..
... 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 Supervisor, Mail Order/OTC Pharmacy Distribution processes and dispenses or directly supports the processing and dispensing of Traditional and Over The Counter prescription orders to be mailed to patients' homes ..
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 ..
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 ..
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 ..
