Clinical Quality Compliance Manager Jobs in Puerto Rico

... process deviations or incidents where quality standards of a product or ... & external customers to ensure compliance & timely completion of investigations ... of investigations activities.?7. ?Support the..

Description The Program Manager, OTC Formulary will work closely ... programs and verify that product quality does not negatively impact the ... over-the-counter formulary that balances product quality with program..

Description The Care Manager, Telephonic Behavioral Health 2, in ... wellbeing of members. The Care Manager, Telephonic Behavioral Health 2 work ... Humana is seeking a Care Manager, Telephonic Behavioral..

Description The Quality Compliance Professional 2 completes annual quality reviews and research. The Quality Compliance Professional 2 work assignments are ... courses of action. Responsibilities The Quality Compliance Professional 2..

... within a context of regulatory compliance, and work is assisted by ... resources, which may include national clinical guidelines, CMS policies and determinations, ... guidelines, CMS policies and determinations,..

... within a context of regulatory compliance, and work is assisted by ... resources, which may include national clinical guidelines, CMS policies and determinations, ... guidelines, CMS policies and determinations,..

... within a context of regulatory compliance, and work is assisted by ... resources, which may include national clinical guidelines, CMS policies and determinations, ... guidelines, CMS policies and determinations,..

... by other healthcare professionals in compliance with review policies, procedures, and ... with 5 years of established clinical experience Knowledge of the managed ... experience leading teams focusing on..

Description The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the ... and/or benefit administration determinations. The Manager, Utilization Management Nursing works within ... you succeed, we succeed!..

Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires ..

Description The Senior Data Manager supports all aspects of configuration ... deficiency reporting. The Senior Data Manager work assignments involve moderately complex ... variable factors. Responsibilities Humana's Health Quality and..

... within a context of regulatory compliance, and work is assisted by ... resources, which may include national clinical guidelines, CMS policies and determinations, ... guidelines, CMS policies and determinations,..

Description The Care Manager, Telephonic Behavioral Health 2 , ... wellbeing of members. The Care Manager, Telephonic Behavioral Health 2 work ... of action. Responsibilities The Care Manager, Telephonic Behavioral..

... The Medical Director relies on clinical background and reviews Medicare drug ... within a context of regulatory compliance and work is assisted by ... Pharmacy Policies and Procedures, and..

... within a context of regulatory compliance, and work is assisted by ... resources, which may include national clinical guidelines, CMS policies and determinations, ... guidelines, CMS policies and determinations,..

... within a context of regulatory compliance, and work is assisted by ... resources, which may include national clinical guidelines, CMS policies and determinations, ... guidelines, CMS policies and determinations,..

... of EMR systems to ensure compliance with industry standards and regulatory ... software to ensure security and compliance with HIPAA regulations Oversee the ... accountability including UI responsiveness, overall..

... with a context of regulatory compliance, and work is assisted by ... resources which may include national clinical guidelines, CMS policies and determinations, ... guidelines, CMS policies and determinations,..

... guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) ... guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) ... meeting departmental expectations, and meets..

... Information Humana Medicaid Associate Director, Compliance Nursing in San Juan Puerto ... Rico Description The Associate Director, Compliance Nursing reviews utilization management activities ... and abuse. The Associate Director,..

... officesrnFacilitates query process to improve clinical documentation to support appropriate reimbursement ... with (Medicare Advantage)rnEducates physicians on clinical documentation opportunities as well as ... thorough and current knowledge of..

Description The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the ... and/or benefit administration determinations. The Manager, Utilization Management Nursing works within ... you succeed, we succeed!..

Description Responsibilities The Compliance Professional 2 has responsibilities for ... 2 has responsibilities for performing clinical audits on medical record documentation ... on medical record documentation for quality and clinical..