THE LARGEST COLLECTION OF HEALTHCARE JOBS ON EARTH
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... to build a world class Data Science and Insights enterprise capability ... Through the strategic interpretation of data, we provide our consumers-physicians, patients, ... and analyzing diverse types of..
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 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 ..
... leverages its advanced knowledge of data, modeling, optimization, and tools. Applies ... that improve the outcomes and quality of the programs we offer. ... operates. Understands and analyzes complex..
... the analysis of situations or data requires an in-depth evaluation of ... of services provided by other healthcare professionals in compliance with review ... whether services provided by other..
... and available resources to promote quality, cost-effective outcomes. Coordinate medical, behavioral ... ACD policy, provide outcome measure data to respective providers; serve as ... ensure care coordination assistance. Ensure..
... the analysis of situations or data requires an in-depth evaluation of ... as well Medical Review, Market Quality Operations, and other processes found ... Develop and implement cost per,..
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 ..
... relationships with physicians, providers and healthcare systems in order to support ... support and improve financial and quality performance within the contracted working ... the analysis of situations or..
... The Strategy Advancement Advisor provides data-based strategic direction to identify and ... (ECM) team needs your business, healthcare and research acumen to solve ... acumen to solve for the..
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 ..
Job Information Humana Medicaid Associate Director, Compliance Nursing in Anchorage Alaska Description The Associate Director, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations ..
... order to process and interpret data from multiple sources. Directs applicable ... Consistently recognizes, promotes, and delivers quality customer service to ensure accomplishment ... and participates in process and..
... acumen to solve for the healthcare challenges of today. The Clinical ... team uses advanced scientific techniques, data analysis, forecasting, and clinical acumen ... various analytical organizations to lead..
Description The Problem, Incident and Event Management Engineer 2 monitors trends in incidents and system issues and helps drive technical support teams to recover services during periods of service disruption or ..
... Member Plan (EFMP), auditing for quality and clinical compliance, and case ... entry and review of CDRL data pertaining to the ACD. Review ... pertaining to the ACD. Review..