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Description The Utilization Management Nurse 2 utilizes clinical nursing ... and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are ... state RN licensed required The Utilization Management..
... Associate Director, Compliance Nursing reviews utilization management activities and documentation to ensure ... to enhance the clinical delivery process. The Associate Director, Compliance Nursing ... problems within department(s), and..
... Understand and engage in risk management procedures such as identifying, coordinating, ... standards; Participate in all quality improvement procedures and adhere to quality ... procedures and adhere to quality..
... Nurse: Serves as a team lead and subject matter expert (SME) ... CarePlus departments Leads implementation of process improvement initiatives based on data analysis ... Reviews inventory reports and..
... to feedback and recommendations by Utilization Review staff. Upon completion of ... courses of action through the utilization of Performance Improvement principles. Responsible for review of ... the QA/PI..
Description The Lead Behavioral Health Medical Director oversees ... doing case reviews themselves. The Lead Behavioral Health Medical Director may ... Health Medical Director may also lead specific functional area..
Description Account Management Lead defines the account management strategy for Humana Pharmacy's commercial ... Pharmacy's commercial accounts. The Account Management Lead works on problems of diverse ... are developed. Leads..
Description The Process Improvement Lead analyzes, and measures the effectiveness ... sustainable, repeatable and quantifiable business process improvements. The Process Improvement Lead works on problems of diverse ... moderate to..
Job Information Humana Process Improvement Lead South Carolina Medicaid (Utilization and Case Management) in Charlotte North Carolina Description ... Charlotte North Carolina Description The Process Improvement Lead analyzes, and measures..
... education opportunities to drive maximum utilization of available resources, and directing ... problems within department(s), and could lead multiple managers or highly specialized ... highly specialized professional associates. Responsibilities..
... performance support, mobile learning and process documents. Plans, organizes, and collaborates ... proficiency testing, and job performance improvement. Makes decisions on moderately complex ... any field Minimum 1 year..
... will work closely with Care Management leaders and Subject Matter Experts ... in the areas of Case Management, Utilization Management and Care Management Support as well as other .....
... development and implementation of quality improvement interventions and audits and assists ... of experience in Accreditation, Quality Management, Compliance, Utilization Management, Behavioral Health, and/or Case Management Exceptional analytical and..
... meetings with Humana's CEO and management team and frequently deliver strategy ... role is modeled after top-tier management consultant experience. As such, day-to-day ... lines of business to reduce..
Description Humana's Enterprise Clinical Management team needs your clinical, business ... various analytical organizations you will lead the clinical review and development ... indicators. Secondly, this role will lead the..
... leader on LTC population health management and the integrated health model, ... through the Peer 2 Peer process, and in some instances these ... health, or disease or care..
... Ensures accuracy of formularies and utilization management (UM) criteria in the Formulary ... and Therapeutics Committee and Drug Utilization Review team meetings Collaborates with ... an expert in Humana's..
... practice of Quality Assessment and Improvement (QAI), including use of FMS ... individual contributor will have significant project/process responsibilities. Program or project responsibility ... and develops a mechanism or..
... of the Clinical Drug Policy Management team which ensures synchronization of ... which ensures synchronization of formulary utilization management policies across multiple systems. Humana ... Active, unrestricted pharmacy licensure..
