Healthcare Improvement Specialist Jobs in Rhode Island

Overview To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, ..

Job Information Humana Actuary, Risk and Compliance in Newport Rhode Island Description This Actuary role is a newly created role within the Senior Products Actuarial Compliance team focused on special Medicare ..

... We are the future of healthcare and our mission is to ... will help members through their healthcare journey, ensuring they get the ... are: Passionate about transforming our..

Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part C Line of Business. The Medical Director provides medical interpretation and determinations ..

Description The Director, Pharmacy Clinical Formulary and Medical Drug Strategies oversees and drives the pharmacy and medical drug formulary strategies across all lines of business (Medicare, Commercial, Medicaid). This position will ..

Quality Improvement/Health Information Specialist (Full Time) Location: Woonsocket, RI POSITION SUMMARY:  Q uality Improvement/Health Information Specialist  in the maintenance of active, pending, and terminated records according to agency and State/Federal standards. ..

Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part C Line of Business. The Medical Director provides medical interpretation and determinations ..

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 ..

Quality Improvement/Health Information Specialist (Full Time) Location: Woonsocket, RI All staff must be vaccinated for COVID-19 prior to starting work, unless a certified medical exemption accommodation is granted. Proof of vaccination ..

Description The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations. The Behavioral Health Medical Director work assignments involve moderately complex to complex issues where the analysis of ..

WalgreensnJob DescriptionIn accordance with state and federal regulations, assists the pharmacist, under direct supervision, in the practice of pharmacy. Assists the pharmacist in the performance of other Pharmacy Department duties in ..

Quality Improvement/Health Information Specialist (Full Time) Location: Woonsocket, RI All staff must be vaccinated for COVID-19 prior to starting work, unless a certified medical exemption accommodation is granted. Proof of vaccination ..

Description The RN Clinical team is looking for a dynamic Registered Nurse to join the team working remote anywhere in the US or in Louisville, KY! We are looking for someone ..

Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health episodic and per diem requests. The Medical Director provides medical interpretation and determinations whether ..

Description The Staff Clinical Pharmacist is an integral part of the Clinical Drug Policy Management team which ensures synchronization of formulary utilization management policies across multiple systems. Humana is seeking a ..

Job Description The Credentialing Coordinator is responsible for initial credentialing and re-credentialing nurse practitioners, physician assistants and physicians in a compliant and timely manner; monitor expired credentials and compliance monitoring in ..

Job Information Humana FP&A Lead, Medicaid Market in Newport Rhode Island Description The Financial Planning & Analysis Lead is acritical leadership role with full market financial oversight over the South Carolina ..

Quality Improvement/Health Information Specialist (Full Time) Location: Woonsocket, RI All staff must be vaccinated for COVID-19 prior to starting work, unless a certified medical exemption accommodation is granted. Proof of vaccination ..

Description The Lead Behavioral Health Medical Director oversees the work of 2 Medical Directors who conduct clinical case reviews of the care received by members in an assigned market, member population, ..

Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part C Line of Business. The Medical Director provides medical interpretation and determinations ..

Quality Improvement/Health Information Specialist (Full Time) Location: Woonsocket, RI All staff must be vaccinated for COVID-19 prior to starting work, unless a certified medical exemption accommodation is granted. Proof of vaccination ..

Job Information Humana Medicare Appeals and Grievance Medical Director in Newport Rhode Island Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare ..

Quality Improvement/Health Information Specialist (Full Time) Location: Woonsocket, RI All staff must be vaccinated for COVID-19 prior to starting work, unless a certified medical exemption accommodation is granted. Proof of vaccination ..