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Description The Clinical Pharmacy Lead monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders. Utilizes broad understanding of managed care and PBM knowledge to develop, and/or ..
... of services provided by other healthcare professionals in compliance with review ... working with health insurance other healthcare providers, patient interaction, etc. Internal ... their home. We are a..
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... or community groups to support regional market care facilitation and priorities, ... whether services provided by other healthcare professionals are in agreement with ... departments, Humana colleagues and the..
Description Healthcare isn't just about health anymore. It is about caring for family, friends, finances, and personal life goals. It's about living life fully. At the Primary Care Organization, a division ..
... or community groups to support regional market priorities, which may include ... whether services provided by other healthcare professionals are in agreement with ... departments, Humana colleagues and the..
... Las Vegas Nevada Description The Healthcare Quality Reporting & Improvement (HQRI) ... nationally. The Associate VP for Healthcare Quality Reporting and Improvement (HQRI) ... guidance to ensure physician and..
... Las Vegas Nevada Description The Healthcare Quality Reporting & Improvement (HQRI) ... guidance to ensure physician and healthcare provider plans, education, reporting and ... across the enterprise to support..
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 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 ..
National Medical Director Utilization Management – Quality Management *Employed*Can work remote*Growing organization*Excellent compensation package and full benefitsrnJob Description: rnrnLeads, develops, directs, and implements clinical and non-clinical activities that impact health care ..
... physician relationships and facilitating Clinical Manager and staff relationships with physicians.Presides ... procedure manuals.Collaborates with the General Manager, Group Vice President of Operations, ... Vice President of Operations, and..
... of services provided by other healthcare professionals in compliance with review ... or community groups to support regional market priorities, which may include ... whether services provided by other..
Description The Manager, Risk Adjustment oversees coding educators and quality assurance audits of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS). ..
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 ..
