Healthcare Performance Improvement Jobs

... all areas impacting DCE operations, performance, experience, and outcomes including provider ... as they relate to provider performance, beneficiary experience, DCE growth, provider ... engagement strategy, identifying and implementing..

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 ..

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 ..

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 ..

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 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..

... 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 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 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 ..

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 ..

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 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 ..

... 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..

... relationships with physicians, providers and healthcare systems in order to support ... and improve financial and quality performance within the contracted working relationship ... across such areas as financial..

... 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..

Description Responsibilities This position will maintain the Humana Military ACD website Autism Center of Excellence (CoE); ensuring educational information is current and relevant to training needs in addition to analyzing and ..

... and actively participates in process improvement activities that enhance the likelihood ... competency evaluations/audits to ensure ongoing performance of other PCT’s. Collaborates with ... the practice of Continuous Quality..

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 ..

... 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 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 ..

... 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..

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,..