Healthcare Regulatory Compliance Jobs in Brentwood

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 ..

... 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..

... Information Humana Medicaid Associate Director, Compliance Nursing in Brentwood Tennessee Description ... Tennessee Description The Associate Director, Compliance Nursing reviews utilization management activities ... and abuse. The Associate Director,..

... 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..

... 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 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 ..

... Information Humana Actuary, Risk and Compliance in Brentwood Tennessee Description This ... within the Senior Products Actuarial Compliance team focused on special Medicare ... special programs, this role supports..

... 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 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 Network Operations Lead maintains provider relations to support customer service activities through data integrity management and gathering of provider claims data needed for service operations. The Network Operations Lead ..

Description The Actuary, Pricing 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 plans ..

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 ... documentation for quality and clinical compliance with contract requirements as outlined ... ensure all providers are in compliance based on..

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 ..