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Description The Senior Policy Governance Professional policy Governance is the combination of Compliance processes established and executed that are reflected in the organization's structure and how it is managed and led ..
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Description The Senior Risk Management Professional identifies and analyzes potential sources of loss to minimize risk. The Senior Risk Management Professional work assignments involve moderately complex to complex issues where the ..
Description Humana's recently created Clinical Resource Team is looking to grow the team with a couple Senior Nurse Auditor roles! This is a unique team that's primary role is to quickly ..
Description The Senior Compliance Professional ensures compliance with governmental requirements. The Senior Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an ..
Description The Senior Quality Assurance, Clinical Professional requires being both a nurse/RN and a certified Coder nurse as this position will be cross trained to review DRG (Diagnosis Related Group) audits ..
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 ..
Description The Senior Market Development Professional provides support to assigned health plan and/or specialty companies relative to Medicare/Medicaid/TRICARE product implementation, operations, contract compliance, and federal contract application submissions. The Senior Market ..
SUMMARY: This position is responsible for leading nurses within an assigned business unit through their day-to-day activities to ensure successful outcomes in the production environment. Responsibilities include: providing clinical guidance-to include ..
Description The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. The ..
Job Information Humana Medicaid Associate Director, Compliance Nursing in Rogers Arkansas Description The Associate Director, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations ..
Description The Pre-Authorization Nurse 2 reviews Genetic testing prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The ..
Description The Care Manager, Telephonic Nurse 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and ..
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 ..
SUMMARY: The Senior Specialist Case Manager shall provide case management services for a designated region. The Sr. Specialist Case Manager shall collaborate with and serve as a liaison for key players ..
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 ..
Description The Senior Clinical Business Professional is a clinical partner to the Commercial Product Strategy team. The Senior Clinical Business Professional work assignments involve moderately complex to complex issues where the ..
Description The Senior Nursing Educator plans, directs, coordinates, evaluates, develops, and/or delivers training and education programs for professional nursing personnel. The Senior Nursing Educator work assignments involve moderately complex to complex ..
Description The Senior Provider Engagement, Clinical Professional develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve financial and quality performance within the ..
Description Humana's recently created Clinical Resource Team is looking to grow the team with a Senior Nurse Auditor roles! This is a unique team that's primary role is to quickly jump ..
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 Author, recently launched by Humana, is a service experience designed to meet the whole-health needs of the people we serve. Created to innovate with the speed and agility of a ..
