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Description The Associate Director, Actuarial Analytics/Forecasting analyzes and forecasts financial, economic, and other data to provide accurate and timely information for strategic and operational decisions. Establishes metrics, provides data analyses, and ..
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Description The Manager, Pharmacy Claims works within specific guidelines and ... D and review of pharmacy claims containing invalid claim elements. Responsibilities ... elements. Responsibilities The Manager, Pharmacy Claims analyzes..
Description The Director, Financial Planning and Analysis - Medicare Supplement collects, analyzes and reports on various Med Supp market data to connect financial outcomes with operational effectiveness. The Director, Financial Planning ..
Description The Care Manager, Telephonic Behavioral Health 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 ..
Description Responsibilities The Associate Director for ACD Audit , at the director of the Director of Payment Integrity, will create and implement process improvement plans focused on the beneficiary and provider ..
Description The Director, Provider Reimbursement is responsible for the leadership, strategy development and execution of Humana Military's provider reimbursement methodologies. This leader is responsible for timely and accurate implementation of Government ..
Description This role has responsibility for the oversight and monitoring of the Autism Care Demonstration (ACD) team performance to ensure compliance with contract and complex ACD policy requirements as defined by ..
Description The Senior Vendor Management Professional works as liaison between vendors and organization. The Senior Vendor Management Professional work assignments involve moderately complex to complex issues where the analysis of situations ..
Description The Associate VP, Retail Senior Products Financial Planning & Analysis is a key member of Medicare leadership team. This role will have direct impact on Medicare pricing and growth strategy, ..
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 Associate Director, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Associate Director, Utilization Management Nursing ..
Description The Senior Project Manager manages all aspects of a project, from start to finish, so that it is completed on time and within budget. The Senior Project Manager work assignments ..
Description Responsibilities The Care Manager, Behavioral Health 2 (BCBA) is responsible for the administration and monitoring of the Autism Care Demonstration (ACD) including coordination of services for ABA Therapy, benefits provided ..
Job Information Humana Medicaid Associate Director, Compliance Nursing in Louisville Kentucky Description The Associate Director, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations ..
Description The Provider Analytics organization's vision is to improve member healthcare through innovative analytics and actionable insights, which empower members, and providers to drive higher quality, lower cost of care, and ..
Description The BI Lead is an integral position in Network Strategy & Analytics team responsible for oversight, design, and development of network analytics applications, centered around ownership of strategic initiatives focused ..
Description Responsibilities The Associate Director Medical/Financial Risk Evaluation leads a few powerful teams dedicated to reducing waste and abuse in the health care industry and its impacts on Humana. These teams ..
Description Reports directly to the Vice President, Medical Management Operations and serves as a member of the HGB Executive Committee. Leads functions related to HGB's Care Management programs to include predictive ..
Description Humana is a Fortune 60 market leader in integrated healthcare whose dream is to help people achieve lifelong well-being. As a company focused on the health and well-being of the ..
Description The Associate VP, Payment Integrity uses technology to detect anomalies in data to identify and collect overpaid claims. Contributes and leads the process of identifying fraud waste and abuse for ..
Description Responsibilities Where you Come In The Manager, Medical/Financial Risk Evaluation identifies, assesses, and mitigates any medical or financial risk that arises from inadequate or failed processes, people, systems, or external ..
Description The AVP, Business Technology Solutions Implementation will oversees various system programs of a highly complex nature to deliver new technological solutions to meet business needs within a specified scope while ..
Description Responsibilities This role within the Autism Care Demonstration (ACD) Team, will work closely with Care Management leaders and Subject Matter Experts in the areas of Case Management, Utilization Management and ..
