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Description The Senior Quality Improvement Professional will focus organizational ... (BH)/Substance Use Disorder (SUD) clinical quality performance measures to achieve optimal ... to achieve optimal performance and quality for the..
Job ID 21000FMNAvailable Openings 2 PURPOSE AND SCOPE: The registered professional nurse (CAP RN 1) position is an entry level designation into the Clinical Advancement Program for Registered Nurses. The CAP ..
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 ..
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... Member Plan (EFMP), auditing for quality and clinical compliance, and case ... entry and review of CDRL data pertaining to the ACD. Review ... compliance with ACD. Monitor for..
Description The Data and Reporting Professional II generates ... system tools and database or data warehouse queries and scripts. The ... warehouse queries and scripts. The Data and Reporting Professional..
... leverages its advanced knowledge of data, modeling, optimization, and tools. Applies ... that improve the outcomes and quality of the programs we offer. ... problems. Understands and analyzes complex..
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 ..
Description The Senior Pre-Authorization Nurse reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. Makes decisions on ..
Job Information Humana Senior Innovation Portfolio Strategy Professional in Charleston West Virginia Description The Humana Healthy Horizons Strategic Solutions team's purpose is to accelerate the ideation and development of transformational initiatives ..
... reducing waste and overuse of healthcare services, while encouraging high value ... care. The team uses advanced data analytic techniques, clinical acumen and ... Trend (CAT) team needs your..
... staff meets all productivity and quality standards. This leader must have ... routine audits to ensure successful quality performance outcomes and compliance standards ... the promotion of the multi-disciplinary..
... the analysis of situations or data requires an in-depth evaluation of ... closing opportunities. Drives improvement of quality outcomes for providers through in-person, ... coding (i.e. identify deficiencies in..
... 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..
... ensuring operationalization of key growth, quality and efficiency strategies. This includes ... Public Health Administration, Public Policy, Healthcare Economics, Business or related field ... Demonstrated expertise in population health,..
Description The Humana Healthy Horizons Strategic Solutions team's purpose is to accelerate the ideation and development of transformational initiatives that maximize customer value to create a differentiated value proposition for Humana ..
... the analysis of situations or data requires an in-depth evaluation of ... architectural strategy Understand and analyze data pipelines, algorithms, and automated systems. ... teams, including developers, engineers, architects,..
... positively impacting members and caregivers quality of life Responsibilities The Strategy ... The Strategy Advancement Lead provides data-backed strategic direction to identify and ... and care manager experience, clinical..
... public policy positions such as: data; resources; subject matter experts; and ... 5 or more years of healthcare policy experience including a track ... research, and resource development supporting..
Job Information Humana Senior Copy Writer in Charleston West Virginia Description Humana's The Hive is looking for a Senior Copy Writer to join the team! The Hive is Humana's in-house agency, ..
... the analysis of situations or data requires an in-depth evaluation of ... architectural strategy Understand and analyze data pipelines, algorithms, and automated systems ... teams, including developers, engineers, architects,..
... Humana Nationwide Medicaid Behavioral Health Quality Lead in Charleston West Virginia ... Virginia Description The Behavioral Health Quality Lead will report directly to ... directly to the National Medicaid..
Job Information Humana Quality Improvement Program Lead (National Medicaid ... Improvement Program Lead (National Medicaid Quality) in Charleston West Virginia Description ... Healthy Horizons is seeking a Quality Improvement Program..
