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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..
... 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 Metairie Louisiana Description ... Louisiana Description The Associate Director, Compliance Nursing reviews utilization management activities ... and abuse. The Associate Director,..
Description The Director, Strategy Advancement provides data-based strategic direction identifying and delivering new avenues of growth is a critical company priority, championed by the SVP of Retail Strategy & Product. We're ..
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 ..
... 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..
... environment for all. Responsibilities The Compliance Professional 2 develops and implements ... Professional 2 develops and implements compliance policies and procedures. Researches compliance issues and recommends changes that .....
Description The Senior Compliance Nurse reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Senior 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 ..
... to local, state, and federal regulatory and programmatic requirements Communicate with ... regarding any necessary operational or regulatory changes Lead conflict resolution for ... may occur Implement and ensure..
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 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 Healthcare isn't just about health anymore. ... of our patients, and the healthcare industry as a whole. The ... industry as a whole. The Compliance Nurse 2 reviews utilization..
... Information Humana Actuary, Risk and Compliance in Metairie Louisiana Description This ... within the Senior Products Actuarial Compliance team focused on special Medicare ... special programs, this role supports..
