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Description The Senior Process Improvement Professional analyzes, and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Senior Process Improvement Professional work assignments ..
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Description The Director, Process Improvement analyzes, and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Director, Process Improvement requires an in-depth understanding ..
Description The Problem, Incident and Event Management Engineer 2 monitors trends in incidents and system issues and helps drive technical support teams to recover services during periods of service disruption or ..
Description The Associate Director, Problem, Incident and Event Management drives technical support teams to recover services during periods of service disruption or outages to key technology platforms/applications. The Associate Director, Problem, ..
Description The Medicaid Clinical Strategy Lead delivers new clinical technological solutions to meet Medicaid business needs within a specified scope while aligned to enterprise objectives. The Medicaid Clinical Strategy Lead works ..
Description The Actuary, 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 works directly ..
Description Responsibilities The Consumer Service Operations Professional 2 evaluates claims oversight performance metrics by interfacing with the sub-contractor to gather and track associated reporting. The Consumer Service Operations Professional 2 evaluates ..
Description The Pharmacy Claims Lead operationalizes and monitors Coordination of Benefits (COB) and subrogation claim processing logic and processes. Exercises independent judgment and decision making on managing staff, complex issues regarding ..
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 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 Staff Clinical Pharmacist manages the formulary processes for the Clinical Formulary Administration team for the Medicaid LOB. The Staff Clinical Pharmacist work assignments involve moderately complex to complex issues ..
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 ..
... 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..
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 ..
... for a Senior Business Systems Analyst to join working remote anywhere ... US! The Senior Business Systems Analyst performs analysis of business, process ... specifications. The Senior Business Systems..
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 The Director, Strategy Advancement provides data-based strategic direction identifying and delivering new avenues of growth is a critical company priority, championed by the SVP of Retail Strategy & Product. We're ..
Description The Hospital Contracting Executive initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Hospital Contracting Executive works on problems ..
Description Come join the Digital Health & Analytics (DH&A) team within Humana to build a world class Data Science and Insights enterprise capability leveraging digital-first platforms, analytics, and agile development methodologies. ..
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 ..
... to: Supports the development and implementation of quality improvement interventions and ... degree Advanced degree in a healthcare-related field Knowledge of NCQA accreditation ... & Health Promotion Accreditation, Multicultural..
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 Medicaid Associate Director, Compliance Nursing in Dover Delaware Description The Associate Director, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations ..
