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Description The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within ..
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 ..
Description The Associate Director, Quality Assurance for Humana/Your Home Advantage (YHA) develops and implements programs to establish and maintain quality standards of existing products and services pertaining to In Home Wellness ..
Description The Associate Director, Utilization Management Nursing uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, ..
Job Information Humana UM Medical Director - Conviva in Cincinnati Ohio Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..
Job Information Humana Bilingual Quality Auditor in Cincinnati Ohio Description The Bilingual Quality Auditor/ Professional 2 ensures that products meet specific Centers for Medicaid and Medicare Services standards of quality. Review ..
Description The Vendor Quality Medical Director will manage clinical vendor quality outcomes for Humana Clinical Operations Team. Responsibilities A full time Medical Director to manage clinical vendor quality outcomes for Humana ..
Job Information Humana Quality Improvement Program Lead (National Medicaid Quality) in Cincinnati Ohio Description Humana Healthy Horizons is seeking a Quality Improvement Program Lead who will be responsible for the end ..
Description The Manager, Risk Adjustment oversees coding educators and quality assurance audits of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS). ..
Description This position is for Enclara Pharmacia, a Humana company. Enclara, is a wholly owned hospice and palliative care pharmacy business acquired by Humana in 2021. Enclara is the nation's largest ..
Description The Manager, Software Engineering codes software applications ... based on business requirements. The Manager, Software Engineering works within specific ... schedules and goals. Responsibilities The Manager, Software Engineering standardizes..
Description The Director, Quality Improvement implements quality improvement programs for all lines of business including annual program description, work plan, and annual evaluation. The Director, Quality Improvement requires an in-depth understanding ..
... in Cincinnati Ohio Description The Healthcare Quality Reporting & Improvement (HQRI) ... guidance to ensure physician and healthcare provider plans, education, reporting and ... regional strategies for physician and..
... in Cincinnati Ohio Description The Healthcare Quality Reporting & Improvement (HQRI) ... nationally. The Associate VP for Healthcare Quality Reporting and Improvement (HQRI) ... guidance to ensure physician and..
Job Information Humana Associate Director, Site Reliability Engineering in Cincinnati Ohio Description The Associate Director, Site Reliability Engineering maintains, integrates and implements software applications within the organization. The Associate Director, Site ..
Job Information Humana Senior Quality Program Delivery Professional (Medicaid) - Remote, US in Cincinnati Ohio Description Humana Healthy Horizons is seeking a Senior Quality Program Delivery Professional who will manage and ..
Description The Associate Director, Quality Improvement implements quality improvement programs for all lines of business including annual program description, work plan, and annual evaluation. The Associate Director, Quality Improvement requires a ..
Job Information Humana Technical Product Manager - Remote in Cincinnati Ohio ... Senior Product Management Professional/Technical Product Manager (TPM) must be able to ... product backlog. The technical product manager..
Description The Manager, Quality Improvement implements quality improvement ... Diagnosis and Testing (EPSDT). The Manager, Quality Improvement works within specific ... schedules and goals. Responsibilities The Manager, Quality Improvement is..
Description The Manager, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Manager, Compliance ..
... & Risk Management Quality Audit (QA) Risk Management Professional 2-Remote, US ... & Risk Management Quality Audit (QA) Risk Management Professional 2, you ... for executing the Compliance Oversight..
