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Description The Senior Quality Assurance, Clinical Professional requires being ... high accountability of compliance and quality and will work assignments involving ... the analysis of situations or data requires an..
... 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..
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... 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..
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 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 ..
... Member Plan (EFMP), auditing for quality and clinical compliance, and case ... entry and review of CDRL data pertaining to the ACD. Review ... compliance with ACD. Monitor for..
... 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..
Description The Clinical Pharmacy Advisor lead, overseeing Humana Pharmacy and Medical Trend, is a dynamic role within Humana. We are seeking a positive and proactive individual to contribute to a high ..
... acumen to solve for the healthcare challenges of today. The Clinical ... team uses advanced scientific techniques, data analysis, forecasting, and clinical acumen ... their skills to assist with..
... through the collection of market data and internal analysis, with a ... infrastructure. Contribute to creation of top-quality presentations for senior leadership on ... and make recommendations from complex..
... 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..
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..
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 Senior Medicaid Quality Data and Reporting Analyst generates ad hoc reports and ... system tools and database or data warehouse queries and scripts. In ... the analysis of..
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..
... 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..
... the analysis of situations or data requires an in-depth evaluation of ... recommend opportunities to optimize vendor quality Facilitate the measurement of success ... and/or service level oversight including..
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 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 ..
