Healthcare Quality Analyst Jobs

Job Information Humana Medicaid Associate Director, Compliance Nursing in Honolulu Hawaii Description The Associate Director, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations ..

Job Information Humana Clinical Pharmacy Lead, Remote in Honolulu Hawaii Description Be a part of an interactive team with broad exposure and scope within Humana. Humana is seeking a positive and ..

... of services provided by other healthcare professionals in compliance with review ... whether services provided by other healthcare professionals are in agreement with ... participating in teams focusing on..

... population health management, contract compliance, quality improvement, and pilot/value-based payment programs. ... and Responsibilities Lead clinical and quality management components of HGB's Integrated ... with effective implementation of the..

Job Information Humana Medical Director - Medicare Pharmacy Appeals in Honolulu Hawaii Description The Medical Director relies on clinical background and reviews Medicare drug requests. The Medical director work assignments involve ..

... population health management, contract compliance, quality improvement, and pilot/value-based payment programs. ... and Responsibilities Lead clinical and quality management components of HGB's Integrated ... with effective implementation of the..

Job Information Humana Technical Product Manager - Remote in Honolulu Hawaii Description The Senior Product Management Professional/Technical Product Manager (TPM) must be able to lead, plan and track all phases of ..

Description The Medical Director's primary responsibility is the review of medical authorizations or claims to determine the medical necessity of a given service or level of care. The Medical Director's work ..

Job Information Humana Medical Director - Texas in Honolulu Hawaii Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to ..

PURPOSE AND SCOPE: The professional registered nurse Outpatient RN CAP 1 is an entry level designation into the Clinical Advancement Program (CAP). This position is accountable and responsible for the provision ..

Description The Oncology Staff Utilization Management Pharmacist is a clinical pharmacist who completes medical necessity and comprehensive medication reviews for prescriptions requiring pre-authorization, with a focus on oncology requests. The Oncology ..

... whether services provided by other healthcare professionals are in agreement with ... whether services provided by other healthcare professionals are in agreement with ... participating in teams focusing on..

Description The Data and Reporting Professional II generates ad hoc reports and regular datasets or report information for end-users using system tools and database or data warehouse queries and scripts. The ..

Job Information Humana Senior Quality Program Delivery Professional (Medicaid) - ... Horizons is seeking a Senior Quality Program Delivery Professional who will ... who will manage and support quality improvement..

Job Information Humana Director, Informatics in Honolulu Hawaii Description The Director, Informatics coordinates with other analytics, IT and business areas across the organization to ensure work is completed with insights from ..

Description The Informaticist 2 coordinates with other analytics, IT and business areas across the organization to ensure work is completed with insights from knowledge SMEs. The Informaticist 2 work assignments are ..

PURPOSE AND SCOPE: The professional registered nurse Outpatient RN CAP 1 is an entry level designation into the Clinical Advancement Program (CAP). This position is accountable and responsible for the provision ..

... Humana members to make informed healthcare decisions. Our key goal is ... help our members obtain high quality, affordable healthcare while keeping our provider networks ... (cost) & Effectiveness..

... Nashville, Tennessee NEW! NEW! Information Analyst Medical Imaging Banner Health Sun ... the Queen's Mission of providing quality healthcare services to Native Hawaiians and ... Health Systems is a..

... whether services provided by other healthcare professionals are in agreement with ... training in transitions of care, quality assurance, utilization management and care ... focusing on transitions of care,..

Job Information Humana Medical Director - S. Florida in Honolulu Hawaii Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..

POSITION FEATURES:Able to Float to all Hawaii Clinics and including GuamPURPOSE AND SCOPE: The professional registered nurse Outpatient RN CAP 1 is an entry level designation into the Clinical Advancement Program ..

... HCS Compliance & Risk Management Quality Audit (QA) Risk Management Professional ... HCS Compliance & Risk Management Quality Audit (QA) Risk Management Professional ... guidelines/procedures. Primary responsibilities for the..