Manager Regulatory Compliance Jobs in Rio Rancho

Description The Manager, Utilization Management Nursing utilizes clinical ... and/or benefit administration determinations. The Manager, Utilization Management Nursing works within ... you succeed, we succeed! The Manager, Utilization Management Nursing..

... Information Humana Medicaid Associate Director, Compliance Nursing in Albuquerque New Mexico ... Mexico Description The Associate Director, Compliance Nursing reviews utilization management activities ... and abuse. The Associate Director,..

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..

Job Information Humana Care Manager, Telephonic Registered Nurse, (RN) 2 ... New Mexico Description The Care Manager, Telephonic Nurse 2 , in ... wellbeing of members. The Care Manager, Telephonic..

RN, Case Manager - Full-time Department: Case Management ... Scope The Registered nurse case manager is responsible for facilitating individualized ... nursing staff, social worker, case manager assistant, utilization review..

Manager of Surgical Services Department: Surgical ... fiscal management, strategic planning, standards compliance, clinical practice, staff development, oversight ... Monitor and approve expenditures. Ensure compliance with all regulatory agencies, governing..

Description The Manager, Utilization Management Nursing utilizes clinical ... and/or benefit administration determinations. The Manager, Utilization Management Nursing works within ... you succeed, we succeed! The Manager, Utilization Management Nursing..

Job Information Humana AVP, MD, Stars and Risk Adjustment Clinical Strategy and Leadership in Albuquerque New Mexico Description The Healthcare Quality Reporting & Improvement (HQRI) organization is seeking an AVP to ..

Manager of Inpatient Units Department: Inpatient ... fiscal management, strategic planning, standards compliance, clinical practice, staff development, oversight ... Monitor and approve expenditures. Ensure compliance with all regulatory agencies, governing..

RN, Case Manager - Part-Time Department: Case Management ... Scope The Registered nurse case manager is responsible for facilitating individualized ... nursing staff, social worker, case manager assistant, utilization review..

Description The Medical Director's primary responsibility is the review of medical authorizations or claims to determine the medical necessity of a given service or level of care. The Medical Director's work ..

Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part C Line of Business. The Medical Director provides medical interpretation and determinations ..

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 Behavioral Health Medical Director makes determinations regarding prior authorization and retrospective reviews for inpatient and outpatient services to ensure that members receive clinically appropriate and medically necessary services. All ..

Emergency Department Manager Department: Emergency Department Location: Rio ... fiscal management, strategic planning, standards compliance, clinical practice, staff development, oversight ... Monitor and approve expenditures. Ensure compliance with all regulatory..

Manager of ICU Department: ICU Location: ... fiscal management, strategic planning, standards compliance, clinical practice, staff development, oversight ... in conjunction with hospital emergency manager, local, state, regional and national..

RN Case Manager - PRN Department: Case Management ... Scope The Registered nurse case manager is responsible for facilitating individualized ... nursing staff, social worker, case manager assistant, utilization review..

Case Manager, RN Full-Time Department: Case Management ... Scope The Registered nurse case manager is responsible for facilitating individualized ... team. The registered nurse case manager will utilize planning, coordination,..

Job Information Humana AVP, Stars and Risk Adjustment National Medical Director in Albuquerque New Mexico Description The Healthcare Quality Reporting & Improvement (HQRI) organization is seeking a talented Physician executive that ..

Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part C Line of Business. The Medical Director provides medical interpretation and determinations ..

Manager of Patient Access (Full Time ... initiatives of the hospital. Ensure compliance with the Joint Commission requirements ... entered into the Hospitals records COMPLIANCE - Review Department operations to..

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 ..

Case Manager- RN - PRN Department: Case ... Scope The Registered nurse case manager is responsible for facilitating individualized ... team. The registered nurse case manager will utilize planning, coordination,..