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... overseeing the vendor's claims processing operations and systems. The Director, Claims Oversight plays a vital ... comprised of four units: claims operations, claims systems change management, claims ... Medical..
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Description Responsibilities The Senior Market/Industry Insights Professional delivers clinical/medical policy insight and information to both internal and external customers for Humana Government Business (HGB). The Senior Market/Industry Insights Professional will draft ..
Description Responsibilities The Senior Clinical Insights Professional delivers clinical policy insight and information to both internal and external customers for Humana Government Business (HGB). The Senior Clinical Insights Professional will draft ..
Description The Director of Product Management for Clinical ... business acumen. Responsibilities As the Director of Product Management for Clinical ... and services. Partners closely with operations, vendors, customer success..
Description The Director, Process Improvement analyzes, and measures ... quantifiable business process improvements. The Director, Process Improvement requires an in-depth ... function or segment. Responsibilities The Director, Process Improvement researches..
Description The Director of Health Services for National ... Services for National Medicaid Clinical Operations utilizes clinical skills to support ... and/or benefit administration determinations. The Director, Health Services requires..
... closely with the Quality Improvement Director, Quality Improvement Manager and pharmacy ... Pharmacist, Registered Nurse, other licensed healthcare professional 3 years of experience ... years of experience working on..
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 The Director, Provider Reimbursement is responsible for ... the organization to include Network Operations, Provider Administration, Claims, and IT. ... team of associates. Responsibilities The Director, Provider Reimbursement develops..
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 Associate Director, Utilization Management Nursing utilizes clinical ... benefit administration determinations. The Associate Director, Utilization Management Nursing requires a ... grow, the National Medicaid Clinical Operations team is..
... closely with the market QI director on a frequent basis. Support ... expertise within the realm of Healthcare Quality operations and improvement methodology, HEDIS/CAHPS and ... a subject matter..
Description The Medical Director actively uses their medical background, ... work. Responsibilities Title: Commercial Medical Director Location: Work At Home - ... weeks. Job Summary The Medical Director's work includes..
... work closely with the Quality Director, Behavioral Health Director, Quality Improvement Manager and those ... or CAHPS) in a quality operations / quality management or office ... Qualifications Bachelor's..
Job Information Humana Medicaid Associate Director, Compliance Nursing in Indianapolis Indiana ... Indianapolis Indiana Description The Associate Director, Compliance Nursing reviews utilization management ... waste, and abuse. The Associate Director,..
Description The UM Administration Coordinator contributes to administration of utilization management. The UM Administration Coordinator performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. ..
Job ID 21000J0GAvailable Openings 2Position Specific Information Sign On Bonus: $1,500 for Dialysis Experience 1420 N Senate Ave, Ste 100, Indianapolis, 46202 PURPOSE AND SCOPE: Functions as part of the hemodialysis ..
Description The Lead Product Manager for Specialty products leads all phases of the product life cycle for Dental, Vision and Life products, from inception to introduction into the marketplace. Responsibilities Position ..
Description Responsibilities The Associate Director for ACD Audit , at ... ACD Audit , at the director of the Director of Payment Integrity, will create ... optimizing operational processes. The..
Description Responsibilities Humana's Corporate Strategy team is a small, high-performing organization that works closely with Humana's senior leadership to chart the course for the company's future. Within Strategy Operations, you will ..
... Humana is a Fortune 60 healthcare company with a history of ... top place to work in healthcare, especially in areas of Diversity ... a personalized, seamless and easy..
... care while maintaining cost-effective clinical operations in accordance with all legal, ... treatments in collaboration with the Director. Plans, coordinates and acts as ... policies, and confers with the..
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 ..
