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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..
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..
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..
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..
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..
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..
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..
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,..
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..
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..
Caregivers Wanted in Kodak, TN Acti-Kare, the premier provider of senior and home care services, is currently seeking experienced caregivers to assist adult clients in their homes. Full-time and part-time..
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..
Our Morristown location covers the following counties: Claiborne, Grainger, Cocke, Hamblen, Jefferson, Hancock SOME OF OUR PERKS: Daily pay Option Available! No need to wait until payday! We offer retention..
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..
