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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 ..
Description Location: Work from Home KY Medicaid Medical Director - The Medical Director's primary responsibility is the review of medical authorizations or claims to determine the medical necessity of a given ..
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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 Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments ..
Description The Clinical Data and Reporting Professional 2 generates ad hoc reports and regular datasets and reporting for clinical leadership decision making. The Clinical Data and Reporting Professional 2 also pulls ..
Description The Actuary, Pricing MA-PD is responsible for setting pricing assumptions, submitting bids, filing and gaining approval of premium rates and rate certifications with regulatory agencies. Supports implementation of rates, new ..
Job Information Humana Research Consulting Lead in Louisville Kentucky Description The Research Consulting Lead performs basic observational and experimental scientific, technological, health economics and outcomes investigation directed toward the acquisition of ..
Description Responsibilities The Care Management Support Assistant 2- ACD Referral Coordinator-will process referrals from Military Treatment Facilities (MTFs) and civilian providers for the ACD program. The ACD Referral Coordinator performs varied ..
Description The Senior Clinical Strategy and Practice Professional builds strategies for development, engagement, best clinical practices and processes for clinical community within the enterprise The Senior Clinical Strategy and Practice Professional ..
Description The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All ..
A helping hand and a gentle heart! Everyone should be comfortable in their home and Granny Nannies wants to make that possible! If it's an ongoing weekly schedule or PRN shifts, ..
Description Responsibilities The Senior Corporate Strategist coordinates input from all major business units to facilitate the integration of individual business unit plans with the corporate plan. May conduct or facilitate periodic ..
A helping hand and a gentle heart! Everyone should be comfortable in their home and Granny Nannies wants to make that possible! ***IMMEDIATE OPENINGS*** Clarksville 4p-6p Mon-Fri and 11a-4p Sat/Sun Jeffersonville ..
Job Information Humana Care Team Medical Director in Louisville Kentucky Description The Care Team Medical Director is responsible for improving the quality of care and outcomes while managing costs for a ..
Description The Vendor Quality Medical Director will manage clinical vendor quality outcomes for Humana Clinical Operations Team. Responsibilities A full time Medical Director to manage clinical vendor quality outcomes for Humana ..
Description The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management ..
Description The Staff Clinical Pharmacist- Clinical Formulary Administration monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders. Utilizes broad understanding of managed care and PBM knowledge ..
Description Responsibilities The Utilization Management Nurse 2 will be responsible for performing clinical audits on medical record documentation for quality and clinical compliance with contract requirements as outlined in the Autism ..
