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... Manager - Standards,Revenue Cycle Systems, Healthcare Phoenix, AZ Job Description: Our ... addressed during and after project implementation, as well as to ensure ... Workflow experience, gap assessment, project..
Description The Manager, Specialty Consumer Engagement oversees the enrollment, education, engagement, and activation duties specific to our Specialty Pharmacy line of business regardless of segment, and for product where warranted. The ..
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 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 Care Manager, Telephonic Nurse 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 and ..
Description The Director, Provider Contracting- Behavioral Health initiates, negotiates, and executes physician, hospital, and/or other provider behavioral health contracts for an organization that provides health insurance. Requires an in-depth understanding of ..
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 ..
Description o Our search is focused on identifying an individual contributor who will take ownership of Medicare risk adjustment programs that fit best with our providers by implementing operational and clinical ..
... physicians, physician groups, and integrated healthcare delivery systems throughout the country. ... delivery systems throughout the country. Healthcare isn't just about health anymore. ... of our members, and the..
Description Our search is focused on identifying a certified coder who will primarily be responsible for conducting prospective and concurrent reviews to identify documentation improvement opportunities according to CMS and ICD-10 ..
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 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 Stars Improvement Clinical Professional develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve quality performance within assigned geographic markets ..
Description The Senior Clinical Business Professional is a clinical partner to the Commercial Product Strategy team. The Senior Clinical Business Professional work assignments involve moderately complex to complex issues where the ..
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 ..
... 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 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 As Humana's Medicaid membership continues to grow, the National Medicaid Clinical Operations team is expanding our shared services organization to enhance the clinical delivery process. The National Medicaid Director of ..
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 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 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 Director, Provider Contracting- Behavioral Health Medicaid initiates, negotiates, and executes physician, hospital, and/or other provider behavioral health contracts for an organization that provides managed Medicaid health insurance. Requires an ..
