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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..
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 ..
... 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 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 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 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 ..
... 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..
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 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 Birmingham Alabama Description ... Alabama Description The Associate Director, Compliance Nursing reviews utilization management activities ... and abuse. The Associate Director,..
