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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..
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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 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 ..
Job Information Humana Compliance Lead - Illinois Medicaid in Lancaster South Carolina Description The Compliance Lead ensures compliance with governmental requirements. The Compliance Lead works on problems of diverse scope and ..
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 ..
... 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 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 ..
... 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..
Job Information Humana Actuary, Risk and Compliance in Lancaster South Carolina Description This Actuary role is a newly created role within the Senior Products Actuarial Compliance team focused on special Medicare ..
... 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..
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 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 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 ..
Description The Medical Coding Auditor Supervisor handles a combination of tasks, including extracting clinical information from a variety of medical records and assigning appropriate procedural terminology and medical codes (e.g., ICD-10-CM, ..
... 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..
... 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 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 Responsibilities The Quality Improvement Lead provides strategic leadership for ... collaboration to drive continuous quality improvement throughout health plan operations, provider ... partnerships to achieve our quality improvement goals..
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 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 ..
