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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 ..
Job Information Humana Medicaid Associate Director, Compliance Nursing in Sandy Utah Description The Associate Director, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations ..
... 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..
... 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 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 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 ..
... 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 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 ..
... 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..
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..
... 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..
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 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..
... 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..
... 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..
... 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..
... 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..
