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Description The Process Improvement Professional 2 analyzes, and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Process Improvement Professional 2 work assignments ..
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Description The Director, QOCA Strategy - serves as the strategic leader in resource utilization; budget and MER oversight; vendor oversight; and for clinician and non-clinician flex associates and off-shore vendor associates ..
Description The Senior Process Improvement Professional analyzes, and measures the ... process improvements. The Senior Process Improvement Professional work assignments involve moderately ... well as other HCS Business Improvement, Technology,..
Description The Senior Claims Research & Resolution Professional manages claims operations that involve customer contact, investigation, and settlement of claims for and against the organization. Approves all claims issues/complaints within contractual ..
... Autism Care Demonstration (ACD) team performance to ensure compliance with contract ... by ACD associates to assure performance compliance. Advises leadership to develop ... KEY ACCOUNTABILITIES 30 % Ensures..
... practice of Quality Assessment and Improvement (QAI), including use of FMS ... coaching and counseling employees, including performance reviews, disciplinary action and terminations. ... Leader responsibilities Responsible for overseeing..
... through TRICARE and other military healthcare programs. High-quality service, cost-effective platforms, ... Ensure adherence to policies and performance standards in accordance with the ... participate in Care Management quality..
... matter expertise on all Quality Improvement Department data sources and report ... to management Work with Quality Improvement team members to create a ... department Gain feedback for service..
Description The Pre-Authorization Behavioral Health Professional 2 reviews prior authorization requests for appropriate care and setting, follows guidelines and policies, and approves services or forwards requests as needed. The Pre-Authorization Behavioral ..
... 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..
Description The Director, Process Improvement analyzes, and measures the effectiveness ... process improvements. The Director, Process Improvement requires an in-depth understanding of ... segment. Responsibilities The Director, Process Improvement researches..
Description The Principal Quality Leader will lead testing and quality collaboration between Business and IT, guiding test strategies and tools and assure adherence to quality standards. Serves as point of contact ..
... that our members receive quality healthcare at an affordable price. You ... recommendations Identify and suggest process improvement opportunities Develop and monitor team ... and coaching, and conduct annual..
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 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 As Lead Actuary of the Risk Predictive Models team, you have an opportunity to both learn more about predictive analytics and machine learning and to see it become very real ..
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 Pharmacy Clinical Advisor Professional 2 is an integral part of the Pharmacy Stars team which is accountable for Humana's Patient Safety and medication related Star measure performance. The Pharmacy ..
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 ..
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 ..
