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... Governance is the combination of Compliance processes established and executed that ... 5 years experience with accrediting compliance for medicare advantage programs. Medicare, ... advantage programs. Medicare, Medicaid, and/or..
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To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations ..
Description The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within ..
... occurs within a context of regulatory compliance, and work is assisted by ... whether services provided by other healthcare professionals are in agreement with ... departments, Humana colleagues and..
... occurs within a context of regulatory compliance, and work is assisted by ... whether services provided by other healthcare professionals are in agreement with ... meeting departmental expectations, and..
Description Responsibilities The Your Home Advantage (YHA) Market Clinical Manager (MCM) will lead a team of Advanced Practice Provider (APP) Clinicians (ARNP and PA) responsible for member outreach with In-Home Wellness ..
Job ID 21000I18Available Openings 1PURPOSE AND SCOPE: Supports FMCNA’s mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements. ..
Description The Behavioral Health Parity Compliance Lead will play an integral ... of our Mental Health Parity Compliance Program. Responsibilities This role is ... monitoring all related behavioral health regulatory..
... Information Humana Medicaid Associate Director, Compliance Nursing in Charlotte North Carolina ... Carolina Description The Associate Director, Compliance Nursing reviews utilization management activities ... and abuse. The Associate Director,..
... environment for all. Responsibilities The Compliance Professional 2 develops and implements ... Professional 2 develops and implements compliance policies and procedures. Researches compliance issues and recommends changes that .....
Job Information Humana Compliance Lead - Illinois Medicaid in ... Charlotte North Carolina Description The Compliance Lead ensures compliance with governmental requirements. The Compliance Lead works on problems of .....
Description The Actuary, Pricing MA-PD is responsible for setting pricing assumptions, submitting bids, filing and gaining approval of premium rates and rate certifications with regulatory agencies. Supports implementation of rates, new ..
... Information Humana Actuary, Risk and Compliance in Charlotte North Carolina Description ... within the Senior Products Actuarial Compliance team focused on special Medicare ... special programs, this role supports..
Description The Pharmacy Claims Lead operationalizes and monitors Coordination of Benefits (COB) and subrogation claim processing logic and processes. Exercises independent judgment and decision making on managing staff, complex issues regarding ..
Description The Director, Strategy Advancement provides data-based strategic direction identifying and delivering new avenues of growth is a critical company priority, championed by the SVP of Retail Strategy & Product. We're ..
Description The Senior Compliance Professional ensures compliance with governmental requirements. The Senior ... with governmental requirements. The Senior Compliance Professional work assignments involve moderately ... variable factors. Responsibilities Seeking Senior..
The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. • Verifies identity ..
Job ID 21000J1ZAvailable Openings 1PURPOSE AND SCOPE: Supports FMCNA’s mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements. ..
Job ID 21000H89Available Openings 1PURPOSE AND SCOPE: Supports FMCNA’s mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements. ..
