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Description Humana Military is the Managed Care Support Contractor (MCSC) for the Department of Defense (DoD) charged with administering the TRICARE health plan in the East Region. While the contract is ..
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... policies and procedures. Participate in Quality Operations including chair Quality Management Committee, complete initial peer ... complete initial peer review on quality of care complaints, complete peer-to-peer ... budget..
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 Care Management Support Assistant 3 contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal ..
... acumen to solve for the healthcare challenges of today. The Clinical ... anywhere The Clinical Trend Program Manager (PM) role designs, communicates, and ... Organization as needed Produce high..
... on medical record documentation for quality and clinical compliance with contract ... for this position . 75% Quality Monitoring Audits. Review and assess ... duties as assigned by Supervisor,..
... 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..
... Director, Compliance Nursing ensures mandatory reporting completed. Conducts and summarizes compliance ... Health Parity, Clinical compliance, and quality performance and staffing management. Detailed ... Audit team to assure high..
... (CCM) organization is seeking a Manager, Fraud & Waste to join ... As the Fraud & Waste Manager at Humana, you will support ... so that our members receive..
Description The Care Manager, Telephonic Behavioral Health 2, in ... wellbeing of members. The Care Manager, Telephonic Behavioral Health 2 work ... Humana is seeking a Care Manager, Telephonic Behavioral..
... acumen to solve for the healthcare challenges of today. The Clinical ... low value care and related healthcare resource waste, with a focus ... news and reports in the..
Description The Care Manager, Telephonic Behavioral Health 2 , ... wellbeing of members. The Care Manager, Telephonic Behavioral Health 2 work ... of action. Responsibilities The Care Manager, Telephonic Behavioral..
Description The Care Manager, Telephonic Nurse 2 , in ... wellbeing of members. The Care Manager, Telephonic Nurse 2 work assignments ... action. Responsibilities The RN Care Manager, Telephonic Nurse..
... services, including utilization management (UM), quality improvement, and value-based payment programs. ... Responsibilities Lead major clinical and quality management components of Humana's BH ... management of psychopharmacology pharmacy benefits..
... 41) market leader in integrated healthcare with a clearly defined purpose ... we are seeking an experienced healthcare leader to join our team ... President, Strategy Advancement for our..
... whether services provided by other healthcare professionals are in agreement with ... departments, Humana colleagues and the Healthcare Clinical Operations. After completion of ... Participates in corporate-wide committees Performs..
Description The Principal Quality Leader will lead testing and ... Leader will lead testing and quality collaboration between Business and IT, ... tools and assure adherence to quality standards. Serves..
