Aetna is looking for a Medical Director to be part of a centralized team that supports the Medical Management staff ensuring timely and consistent responses to members and providers related to precertification, concurrent review, and appeal request. The Medical Director is a work-at-home position lo...
The Medical Director (MD) for Aetna One Advocacy is responsible for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high quality, constituent responsive medical care. The MD is a critical medical/business leader resource for ex...
Perform detailed analysis of complex business process requirements and provide appropriate system solutions. Conduct workshops to collect business requirements. Map client business requirements, processes, and objectives. Proactively propose business process and system enhancements. ...
Performs modeling of data sources and flows, works with data management staff to define an operational framework that will define, develop and implement policies and security frameworks to ensure precise and secure delivery of knowledge and information. Perform modeling of data sources and flows, wo...
Have a strong understanding and application of project management principles, concepts, practices, and standards to coordinate and manage broad analysis projects. R&D data collection and management, project-level and program-level. Master’s or Doctoral degree with 6+ years of analysis project manage...
POSITION: Background Field Investigator – (Entry Level) - Omaha, Nebraska. Attend and successfully pass all required training which includes 4-week virtual classroom training and 2-week in person mentorship with Senior Investigator. Office of Personnel Management investigator training. Communicate e...
Certified Business Analysis Professional (CBAP), Certification from International Institute of Business Analysis preferred. Ensure the accuracy and completeness of provider data change requests by submitting them according to market-specific business rules, facilitating the accurate and timely payme...
Uses regular judgement and discretion to collaborate with customers in order to: Understand capability needs; Gather project specifications; Create business cases and cost sheet analysis; Translate high-level business needs into detailed requirements for new capabilities (and change request/enhancem...
To manage a staff of data analysts; to develop complex reports and analyze company data including Corporate or client specific data; to serve as a technical resource for company staff on data analysis and benchmarking issues; to meet with clients on such issues as necessary; to provide training and ...
Work with leaders, product engineers and user experience researchers to understand customer data and explore opportunities to turn qualitative data into quantitative data for use in recommendation models. Use analytical rigor and statistical methods to analyze large amounts of data, extracting actio...
This job consults with cross-functional groups and levels to identify data and analytical needs, conduct analyses, review analyses and findings with leadership, facilitate related process/data improvement efforts, and develop executive level presentations. Develop and implement data collection syste...
Senior Project Manager / Global Project Lead. Associate Director, Project Management. ...
If acting in the capacity as a clinical pharmacist the incumbent may also review UM requests; provide consultation into the case and disease management identification process, and consult with the Organization's Associate Medical Directors and Medical Directors when appropriate, follow-up on appeals...
Cardinal Health manages the pharmacy at Brodstone Memorial Hospital, and we are currently recruiting for a PRN Pharmacist to work as needed covering vacation/PTO and upcoming maternity leave. Working in a hospital system pharmacy outsourced to Cardinal Health, the Pharmacist II adjusts and dispenses...
Curriculum Design and Implementation Oversight in collaboration with NIMAA’s Clinical DirectorEnsure that course content reflects the desired content for NIMAAWork with instructors and guest faculty to shape content and format of all curriculum for NIMAAEnsure that content reflects appropriate hours...
Lead Project Managers and/or Program team in the development and maintenance of comprehensive plans for a defined program. Deliver presentations of project status to effectively communicate throughout the project life-cycle. Adhere to the Organization's project management methods, project life-cycle...
Constantly look for useful attributes to expand our core data assets from various data sources, like US census bureau, and validate the usefulness of the new data. You will have the opportunity to train yourself, with help from more senior team members, on using various data tools to analyze various...
This position will require the skillset of an experienced project manager who has successfully delivered large scale, multi-phased system implementations with multiple work streams, numerous different types of stakeholders and the ability to comfortably deliver updates and relay information to vendo...
The Duals Care Management (CM) Medical Director will participate in designing, developing and deploying our Models of Care across all markets. Consults with plan medical staff regarding adverse determinations, addresses issues related to network providers, performs medical chart reviews, and conduct...
Ensures data integrity and compliance by performing data cleansing, data audit and/or data validation. Ensure data integrity and compliance by performing data cleansing, data audit and/or data validation. Provides business process, system support and data quality governance through data coordination...
The Medical Director will provide qualified medical direction and consultation for care delivery and complex case management for our community-based palliative care program. The medical director will partner with the APP, RN and SW as needed to interact/ communicate with the primary care physician a...
As a Project Development Manager, a typical day for you may include: · Responsibility of project site safety during project development/audit phase · Customer satisfaction · Project leadership · Development of project plan, schedule, and budget · Lead, plan, organize and participate in Investment Gr...