- Magellan Health Services (Honolulu, HI)
- …Project management skills and demonstrated experience. General Job Information Title Quality Clinical Reviewer - Remote Grade 25 Work Experience - ... and external reporting. Interacts with multiple stakeholders internally and externally. Provides clinical reviews of Quality of Care (QOC) and Critical/Adverse… more
- Magellan Health Services (Honolulu, HI)
- …facilities, develops discharge plans and oversee their implementation. + Performs quality clinical reviews while educating and making appropriate interventions ... Job Information Title HMSA Care Manager - BH, UM Reviewer - Remote Hawaii Grade 24 Work...Remote Hawaii Grade 24 Work Experience - Required Clinical Work Experience - Preferred Education - Required Associate… more
- Takeda Pharmaceuticals (Honolulu, HI)
- …the clinical team. + Demonstrated ability to independently lead the development, review , and approval of all clinical document types (ie, those typically ... therapeutic area depending on the scope and stage of clinical development and may or may not have direct...to other writers to ensure the timely delivery of high- quality documents that are scientifically rigorous, logically organized, and… more
- HealthEdge Software Inc (Honolulu, HI)
- …user experience, client needs and organizational and business priorities, while maintaining the clinical quality and standards of our product. Because you will ... or clinical improvement opportunities. + Lead the clinical review of existing clinical ...author corresponding surveys & alerts that leverage evidence-based guidelines, clinical best practices and key quality improvement… more
- Magellan Health Services (Honolulu, HI)
- …for NCQA and URAC certifications. Develops and provides leadership for NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the ... clinical lead senior medical director, and quality improvement staff. May participate in various committees or...Information Title Medical Director (Behavioral Health) - Hawaii Licensed, Remote Grade 36 Work Experience - Required Clinical… more
- Takeda Pharmaceuticals (Honolulu, HI)
- …support as needed. You will formulate the writing strategy for key clinical and regulatory documents and regulatory submissions; guides medical writing document ... including coordination of assignments to Takeda and contract writers; provides review and substantive editing of documents. As necessary, may assume primary… more
- Takeda Pharmaceuticals (Honolulu, HI)
- …and executes a labeling implementation plan to incorporate new scientific, safety and clinical data, as well as Health Authority responses / feedback into CCDS, USPI ... support to Local Affiliates for responses to health authorities requests, review of local labeling exceptions and alignment deferrals, etc. Escalation Process… more
- Humana (Honolulu, HI)
- …community and help us put health first** Be a part of our Pharmacy Clinical Programs Overutilization Review and Monitoring team. Provide guidance to members who ... management. + Prepare presentations and communication materials on behalf of the Clinical Programs Overutilization Review and Monitoring. + Coordinate and plan… more
- Highmark Health (Honolulu, HI)
- …our community-based palliative care program. In addition, this role will provide clinical leadership and guidance to the regional interdisciplinary team. The medical ... of care are practiced. This position will take an active role in quality improvement including tracking and trending of metrics, establishment of quality … more
- Centene Corporation (Honolulu, HI)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and ... the applicable state required. Master's degree for behavioral health clinicians required. Clinical knowledge and ability to review and/or assess treatment plans… more
- J&J Family of Companies (Honolulu, HI)
- …Germany, Spain and France. This is a global role and is open to other countries. Remote work options may be considered on a case-by-case basis and if approved by the ... with strategic responsibilities as it relates to the delivery of high- quality regulatory documentation. This position will focus on submission strategies across… more
- Humana (Honolulu, HI)
- …this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review ... and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials,… more
- Merck (Honolulu, HI)
- …medical knowledge and editorial skills to contribute to medical education and clinical decision support for healthcare professionals, while also providing high ... quality content for patient education. You would be joining...billion users each year. A minimum of 5 years clinical experience and demonstrated writing skills are mandatory. Current… more
- CVS Health (Honolulu, HI)
- …enterprise and provides clinical oversight and mentorship for CVS Health clinical programs, PBM Clinical Quality activities, consultative support to ... when appropriate. - Medical Directors will participate in inter-rater review activities and other quality oversight processes... clinical oversight and mentorship for CVS Health clinical programs, PBM Clinical Quality … more
- Cardinal Health (Honolulu, HI)
- …oncology practice market strategies, alternative pricing structures, new processes, or clinical service line development. + Review regular organization‐wide ... Senior Data Analyst performs analysis and data assessment to support the clinical , financial, and operational modeling needs of the Navista and partnered practices.… more
- HealthEdge Software Inc (Honolulu, HI)
- …report to the Chief Medical Officer of Healthedge (HE) and ensure that our clinical suite of products (GuidingCare & Wellframe) support our health plan customers in ... with the regulatory bodies that govern them: NCQA (National Committee for Quality Assurance), CMS (Centers for Medicare & Medicaid Services), URAC (Utilization … more
- Merck (Honolulu, HI)
- …(transition of care) using approved messages and resources + Conducts appropriate business review of account performance to optimize net sales for our Company ** ... Clinical :** + Communicate to customers the clinical ...corporate personnel, medical directors in charge of provider networks, quality directors, pharmacy directors, financial directors, COO, CEO. +… more
- CVS Health (Honolulu, HI)
- …system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. **This is ... a remote based (work from home) role preferably resides in...members and providers. In addition you will oversee utilization review / quality assurance, directing case management. In this… more
- Humana (Honolulu, HI)
- …your best at Humana. Join Us!** The UM Administration Coordinator 2 provides non- clinical support for the policies and procedures ensuring best and most appropriate ... for a UM Administration Coordinator 2 that will provide non- clinical support for the policies and procedures ensuring best...the nursing team + Builds and pends authorizations for review + Responsible for inbound and outbound calls to… more
- Humana (Honolulu, HI)
- …In this role, you will collaborate with technology groups and leadership in the clinical space to ensure the highest quality of architectural design and provide ... play a pivotal role in the strategic expansion and modernization of our Clinical applications. This position is crucial in supporting our commitment to enhancing… more