• Stars Program Delivery Senior Professional - HEDIS…

    Humana (Austin, TX)
    **Become a part of our caring community and help us put health first** Health Quality and Stars (HQS) is an organization that is responsible for improving ... health outcomes and advancing the care experience of our...quality as rated by the Centers for Medicare and Medicaid Services (CMS). The CMS Stars quality rating system… more
    Humana (09/03/25)
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  • Medical Director (Marketplace)

    Molina Healthcare (Austin, TX)
    …director, and quality improvement staff. + Facilitates conformance to Medicare, Medicaid , NCQA and other regulatory requirements. + Reviews quality referred issues, ... license without restrictions to practice and free of sanctions from Medicaid or Medicare. **PREFERRED EDUCATION:** Master's in Business Administration, Public … more
    Molina Healthcare (08/28/25)
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  • Medical Director - Medicare Grievances and Appeals…

    Humana (Austin, TX)
    **Become a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Must be passionate about contributing to… more
    Humana (09/06/25)
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  • Corporate Medical Director - Medicare Grievances…

    Humana (Austin, TX)
    **Become a part of our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims ... clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and/or Commercial products + Must be passionate about contributing to an… more
    Humana (09/05/25)
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  • Associate Actuary

    Humana (Austin, TX)
    **Become a part of our caring community and help us put health first** The Associate Actuary, Valuation is responsible for estimates of short term and long term ... Insurance lines of business, with a primary focus on Medicaid . The Associate Actuary, Valuation will also assist with...**Preferred Qualifications** + 3 or more years of relevant health -related actuarial work experience + 3 or more years… more
    Humana (09/04/25)
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  • Utilization Management Registered Nurse

    Humana (Austin, TX)
    … health insurance, evaluating medical necessity and appropriateness of care + Health Plan experience + Previous Medicare/ Medicaid Experience a plus + ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
    Humana (09/04/25)
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  • Senior Data Scientist

    Humana (Austin, TX)
    **Become a part of our caring community and help us put health first** The Senior Data Scientist uses mathematics, statistics, modeling, business analysis, and ... modeling and analytics in support of our Medicare and Medicaid business. The HQRI team plays a pivotal role...+ Master's degree or higher education + Experience in health care, insurance, or risk adjustment **This position is… more
    Humana (09/06/25)
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  • Senior Research Scientist

    Humana (Austin, TX)
    **Become a part of our caring community and help us put health first** The Senior Research Scientist participates in research study design, analysis and ... modeling and analytics in support of our Medicare and Medicaid business. The HQRI team plays a pivotal role...+ Master's degree or higher education + Experience in health care, insurance, or risk adjustment **This position is… more
    Humana (09/06/25)
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  • Research Scientist 2

    Humana (Austin, TX)
    **Become a part of our caring community and help us put health first** The Research Scientist 2 participates in research study design, analysis and interpretation of ... modeling and analytics in support of our Medicare and Medicaid business. The HQRI team plays a pivotal role...+ Master's degree or higher education + Experience in health care, insurance, or risk adjustment **This position is… more
    Humana (09/06/25)
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  • Staff Utilization Management Pharmacist (VSP/PT)

    Humana (Austin, TX)
    **Become a part of our caring community and help us put health first** The Staff Utilization Management Pharmacist (VSP/PT) is a clinical expert responsible for ... residence + Eligibility to participate in federal prescription programs (eg, Medicare/ Medicaid ) + Self-directed with the ability to work effectively both… more
    Humana (08/27/25)
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