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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..
Job ID 21000HX8Available Openings 3PURPOSE 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..
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 ..
... 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..
... 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..
Job ID 21000FM5Available Openings 3PURPOSE 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 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 ..
Job ID 21000GNCAvailable 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. ..
... Information Humana Medicaid Associate Director, Compliance Nursing in Birmingham Alabama Description ... Alabama Description The Associate Director, Compliance Nursing reviews utilization management activities ... and abuse. The Associate Director,..
... philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements. Ensure ... in accordance with all legal, compliance, and regulatory requirements and programs. Adheres..
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 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 ..
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 ..
