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Description The Principal Quality Leader will lead testing and quality collaboration between Business and IT, guiding test strategies and tools and assure adherence to quality standards. Serves as point of contact ..
Job Information Humana Manager, Utilization Management Nursing - Medicare ... in Dover Delaware Description The Manager, Utilization Management Nursing utilizes clinical ... and/or benefit administration determinations. The Manager, Utilization Management..
Job Information Humana Manager, Pharmacy and Medical Trend in Dover Delaware Description This leader will oversee a team charged with monitoring, reporting and projecting Humana's drug trends, both pharmacy and medical, ..
Description Humana is a $90 billion (Fortune 40) market leader in integrated healthcare with a clearly defined purpose to help people achieve lifelong well-being. As a company focused on the health ..
Description The Director, Pharmacy Clinical Pipeline oversees the medical and pharmacy drug pipeline tracking and forecasting, supports financial sales analysis and market event news. This position will work and collaborate with ..
... 40) market leader in integrated healthcare with a clearly defined purpose ... we are seeking an accomplished healthcare leader for the newly-created role ... quality, appropriate, and cost-effective behavioral..
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 ..
Independent Living Program Manager in our New Castle County office. Bachelor's degree preferred Associate's degree in Human Services or 2 years equivalent experience and training is required. Must be able to ..
Description The Behavioral Health Medical Director makes determinations regarding prior authorization and retrospective reviews for inpatient and outpatient services to ensure that members receive clinically appropriate and medically necessary services. All ..
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 Manager, STARS Improvement develops, implements, and manages oversight of the company's Medicare Stars Program. This position will manage the Stars improvement team. Responsibilities The Manager, STARS Improvement develops the ..
Job Information Humana Technical Product Manager - Remote in Dover Delaware ... Senior Product Management Professional/Technical Product Manager (TPM) must be able to ... product backlog. The technical product manager..
Job Information Humana Senior Project Manager -- Remote in Dover Delaware ... Delaware Description The Senior Project Manager manages all aspects of a ... within budget. The Senior Project Manager..
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 ..
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 ..
Job Information Humana Medicare/Medicaid Program Manager -- Remote in Dover Delaware ... looking for an experienced Program Manager (internally known as an Acquisition ... contracts. As a Medicaid/Medicare Program Manager..
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 ..
Job Information Humana Manager, Utilization Management RN - Remote ... in Dover Delaware Description The Manager, Utilization Management Nursing utilizes clinical ... and/or benefit administration determinations. The Manager, Utilization Management..
