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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 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 ..
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Description The Care Manager, Telephonic Behavioral Health 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward ..
... Member Plan (EFMP), auditing for quality and clinical compliance, and case ... compliance with ACD. Monitor for quality standards, claims accuracy, fraud, and ... Qualifications BCBA (Board Certified Behavior..
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 Be a part of an interactive team with broad exposure and scope within Humana. Humana is seeking a positive and proactive individual to contribute to a high performing team that ..
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 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 The Principal Quality Leader will lead testing and ... Leader will lead testing and quality collaboration between Business and IT, ... tools and assure adherence to quality standards. Serves..
... the development and implementation of quality improvement interventions and audits and ... years of experience in Accreditation, Quality Management, Compliance, Utilization Management, Behavioral ... degree Advanced degree in a..
Description The Senior Medicaid Quality Data and Reporting Analyst generates ad hoc reports and ... factors. Responsibilities The Senior Medicaid Quality Data and Reporting Analyst will be responsible for the..
Description Come join the Digital Health & Analytics (DH&A) team within Humana to build a world class Data Science and Insights enterprise capability leveraging digital-first platforms, analytics, and agile development methodologies. ..
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 ..
Description Humana's Enterprise Clinical Management team needs your clinical, business and analytics acumen to solve for the healthcare challenges of today. The Clinical Analytics and Trend team uses advanced scientific techniques, ..
Description The Sr. Consumer Experience Professional performs data analysis supporting learning plans via management and usage of consumer behavioral, demographic, and attitudinal data. The Sr. Consumer Experience Professional work assignments involve ..
Description The Informaticist 2 coordinates with other analytics, IT and business areas across the organization to ensure work is completed with insights from knowledge SMEs. The Informaticist 2 work assignments are ..
Description The Care Manager, Telephonic Nurse 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and ..
Description Responsibilities The Business Support Coordinator 1 performs medical record content analysis to ensure compliance with requirements of the TRICARE contract. Prepare, scan, and stage for final distribution all medical records ..
Description The Market Research Professional 2 performs data analysis supporting learning plans via management and usage of consumer behavioral, demographic, and attitudinal data. The Market Research Professional 2 work assignments are ..
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 Responsibilities The Care Management Support Assistant 2- ACD Referral Coordinator-will process referrals from Military Treatment Facilities (MTFs) and civilian providers for the ACD program. The ACD Referral Coordinator performs varied ..
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 ..
