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Description The Senior Policy Governance Professional policy Governance is the combination ... Governance is the combination of Compliance processes established and executed that ... goals. The Senior Policy Governance Professional..
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Description The Senior Risk Management Professional will be responsible for managing ... Responsibilities The Senior Risk Management Professional will be dedicated to supporting ... responsible for developing a vendor compliance..
... Information Humana Medicaid Associate Director, Compliance Nursing in Glen Allen Virginia ... Virginia Description The Associate Director, Compliance Nursing reviews utilization management activities ... and abuse. The Associate Director,..
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 Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All ..
Description The Senior Compensation Professional develops, implements, and administers compensation programs. The Senior Compensation Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires ..
... The Senior Health Information Management Professional ensures data integrity for claims ... The Senior Health Information Management Professional work assignments involve moderately complex ... The Senior Health Information Management..
Job Information Humana Assoicate Actuary, Pricing MA-PD Medicare Advantage Prescription Drug-2 in Glen Allen Virginia Description The Associate Actuary role is a newly created role within the Senior Products Actuarial Medicare ..
Description The Senior Health Information Management Professional ensures data integrity for claims errors. The Senior Health Information Management Professional work assignments involve moderately complex to complex issues where the analysis of ..
Description Responsibilities The Autism Care Demonstration (ACD) Senior Learning Design Professional analyzes content, organizes content, designs solutions, and writes storyboards, scripts, performance support, newsletters and notification letters. Analyzes learning needs and ..
Description The Senior Compliance Professional ensures compliance with governmental requirements. The Senior ... with governmental requirements. The Senior Compliance Professional work assignments involve moderately complex ... variable factors. Responsibilities Seeking..
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 ..
... and processes necessary to maintain compliance with NCQA and MMOC standards ... leadership to achieve and maintain compliance. Collect and analyze data daily, ... of SCM nurses queues for..
Description The Behavioral Health Parity Compliance Lead will play an integral ... of our Mental Health Parity Compliance Program. Responsibilities This role is ... Healthy Horizons Mental Health Parity Compliance..
Description Be a part of the CenterWell leadership team, a subsidiary whose purpose is to provide care management program support resources to physicians, physician groups, and integrated healthcare delivery systems throughout ..
Job Information Humana Senior Accreditation Professional in Glen Allen Virginia Description ... Virginia Description The Senior Accreditation Professional works in a team environment ... performing complex tasks related to compliance..
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 Responsibilities The Compliance Professional 2 has responsibilities for performing clinical ... documentation for quality and clinical compliance with contract requirements as outlined ... ensure all providers are in compliance..
Description The Director, Provider Reimbursement is responsible for the leadership, strategy development and execution of Humana Military's provider reimbursement methodologies. This leader is responsible for timely and accurate implementation of Government ..
Description Responsibilities This position will maintain the Humana Military ACD website Autism Center of Excellence (CoE); ensuring educational information is current and relevant to training needs in addition to analyzing and ..
