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u003cpu003eu003cstrongu003eThis job exists to:u003c/strongu003e perform audits of the documentation and posted CPT, HCPCs and ICD-10 codes of a sample of billed claims to determine whether services ordered by providers are rendered ..
Description The Senior Quality Assurance, Clinical Professional requires being both a nurse/RN and a certified Coder nurse as this position will be cross trained to review DRG (Diagnosis Related Group) audits ..
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 Senior Medicaid Quality Data and Reporting Analyst generates ad hoc reports and regular datasets or report information for end-users using system tools and database or data warehouse queries and ..
Description The Senior Pharmacy Sales Executive leverages targeted geographic analysis, engages with Physician offices to influence physicians to route patients' prescriptions to Humana Pharmacy for fulfillment. The Senior Pharmacy Sales Executive ..
Description The Clinical Pharmacy Lead monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders. Utilizes broad understanding of managed care and PBM knowledge to develop, and/or ..
