Regulatory Compliance Specialist Jobs in Dover

Contract Specialist, GS 05-15 Duties: The candidate will provide business advice and to perform all pre-award and post-award functions for a wide variety of complex and/or specialized acquisitions, using a wide ..

Contract Specialist, GS 05-15 Duties: The candidate will provide business advice and to perform all pre-award and post-award functions for a wide variety of complex and/or specialized acquisitions, using a wide ..

Description This role is on the Humana At Home Special Needs Plan Compliance Review team within Home Solutions Compliance and Risk Management. The Quality Assurance Professional 2 performs audits to establish ..

Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health episodic and per diem requests. The Medical Director provides medical interpretation and determinations whether ..

... seeking a Software Entitlement and Compliance Specialist who will be accountable for ... including full software lifecycle management, compliance, optimization, audit data requests and ... where the Software Entitlement..

Description The Lead, IT Compliance assesses the most complex new ... systems procedures follow corporate standards, regulatory requirements, and best practice frameworks. ... practice frameworks. The Lead, IT Compliance works..

Job Information Humana FP&A Lead, Medicaid Market in Dover Delaware Description The Financial Planning & Analysis Lead is acritical leadership role with full market financial oversight over the South Carolina Medicaid ..

... business areas to drive operational compliance. Humana is seeking a Risk ... will drive operational excellence, advance compliance results, and confirm audit readiness ... with business areas, Market leaders,..

Description Introduction The 3rd Party Segment Lead will execute and lead a team of risk professionals in conducting cyber and regulatory-driven assessments and oversight of key 3rd Parties across designated business ..

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 Supervisor, Compliance Nursing reviews utilization management activities ... waste, and abuse. The Supervisor, Compliance Nursing works within thorough, prescribed ... analytical approach. Responsibilities The Supervisor, Compliance Nursing ensures..

... seeking a Software Entitlement and Compliance Specialist who will be accountable for ... including full software lifecycle management, compliance, optimization, audit data requests and ... Software Asset Management Entitlement..

Description The Compliance Lead (SNP) ensures compliance with governmental requirements. The Compliance Lead works on problems of ... moderate to substantial. Responsibilities The Compliance Lead (SNP) develops and implements .....

Principal Compliance Specialist, Corporate Functions and Payment Duties: ... assists with the research of regulatory compliance requirements and evaluating the adequacy ... identification, assessment, and communication of compliance program risks..

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 ..

Job Information Humana Medicare Appeals and Grievance Medical Director in Dover Delaware Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part ..

Description Job Description Summary The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations ..

Job Information Humana Medical Director - Medicare Pharmacy Appeals in Dover Delaware Description The Medical Director relies on clinical background and reviews Medicare drug requests. The Medical director work assignments involve ..

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 Senior Compliance Professional ensures compliance with governmental requirements. The Senior ... with governmental requirements. The Senior Compliance Professional work assignments involve moderately ... variable factors. Responsibilities Seeking Senior..

Principal Compliance Specialist Duties: Maintains and enhances department ... in support of the overall compliance program components. Assists with researching ... program components. Assists with researching regulatory compliance requirements and..

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 Compliance Lead ensures compliance with governmental requirements. The Compliance Lead works on problems of ... & Analytics to ensure continued compliance through innovative product offerings and ... and..