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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 ..
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Description The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All ..
Job Information Humana Research Consulting Lead in Brentwood Tennessee Description The Research Consulting Lead performs basic observational and experimental scientific, technological, health economics and outcomes investigation directed toward the acquisition of ..
Description SeniorBridge Home Care is seeking a Home Care Recruiter. The recruiter sources talent and coordinates prospective employees for hourly position interviews, and manages all job postings within a defined territory. ..
Description The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments ..
Description The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management ..
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 The Senior Clinical Strategy and Practice Professional builds strategies for development, engagement, best clinical practices and processes for clinical community within the enterprise The Senior Clinical Strategy and Practice Professional ..
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 ..
Description The Actuary, Pricing MA-PD is responsible for setting pricing assumptions, submitting bids, filing and gaining approval of premium rates and rate certifications with regulatory agencies. Supports implementation of rates, new ..
Job Information Humana Senior Accreditation Professional in Brentwood Tennessee Description The Senior Accreditation Professional works in a team environment on Humana's health plan accreditations, performing complex tasks related to compliance with ..
Description The Care Management Support Assistant 2 (CMSA2) contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain ..
Description The Staff Consultative Pharmacist consults with patients, pharmacies and providers to provide patient care in the form of optimal medication therapy. The Staff Consultative Pharmacist work assignments involve moderately complex ..
Description The Staff Clinical Pharmacist- Clinical Formulary Administration monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders. Utilizes broad understanding of managed care and PBM knowledge ..
Job Information Humana Actuary, Risk and Compliance in Brentwood Tennessee Description This Actuary role is a newly created role within the Senior Products Actuarial Compliance team focused on special Medicare Advantage ..
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 Provider Contracting Executive initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Provider Contracting Executive works on problems ..
Description The Pharmacy Clinical Advisor Professional 2 is an integral part of the Pharmacy Stars team which is accountable for Humana's Patient Safety and medication related Star measure performance. The Pharmacy ..
Description The Clinical Data and Reporting Professional 2 generates ad hoc reports and regular datasets and reporting for clinical leadership decision making. The Clinical Data and Reporting Professional 2 also pulls ..
