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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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... in process consulting to support compliance within the Healthcare Services (HCS) organization. As a ... (HCS) organization. As a HCS Compliance & Risk Management Professional, you ... effectiveness 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..
... with DOI (Department of Insurance) regulatory and compliance requests Bachelor's degree and 5 ... degree and 5 years of healthcare regulatory experience 2 years of project ... creating analytics..
Description The Home Compliance & Risk Management Lead contributes ... strategy by supporting risk and compliance initiatives across Home Solutions teams ... Home Solutions teams within the Healthcare Services organization...
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 ..
Description The Manager, Care Management leads teams of nurses and behavior health professionals responsible for care management. The Manager, Care Management works within specific guidelines and procedures; applies advanced technical knowledge ..
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 ..
Description The Senior Quality Assurance, Clinical Professional requires being both a nurse/RN and a certified Coder nurse as this position will be cross trained to review DRG (Diagnosis Related Group) audits ..
... Information Humana Medicaid Associate Director, Compliance Nursing in Rogers Arkansas Description ... Arkansas Description The Associate Director, Compliance Nursing reviews utilization management activities ... and abuse. The Associate Director,..
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 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 ..
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..
... 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..
