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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 Compliance Lead (SNP) ensures compliance with governmental requirements. The Compliance Lead works on problems of diverse scope and complexity ranging from moderate to substantial. Responsibilities The Compliance Lead (SNP) ..
Description The Senior Compliance Professional ensures compliance with governmental requirements. The Senior Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an ..
Description The Supervisor, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Supervisor, Compliance ..
Description Healthcare isn't just about health anymore. It's about caring for family, friends, finances, and personal life goals. It's about living life fully. At Humana, we want to help people everywhere, ..
Description The Director, Pharmacy Clinical Formulary and Medical Drug Strategies oversees and drives the pharmacy and medical drug formulary strategies across all lines of business (Medicare, Commercial, Medicaid). This position will ..
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 ..
Property Preservation Specialist The candidate will ensure the properties are inspected and preserved in accordance with statutory compliance, regulatory compliance, and company guidelines. Manage property preservation vendor(s) that are fulfilling tasks ..
... contract requirements, provide research and regulatory interpretation, perform auditing and monitoring, ... will: Interpret and define Medicaid regulatory and contract requirements to be ... be used to evidence meeting..
Job Information Humana Pharmacy Special Investigations Professional (Fraud, Waste & Abuse) Remote in US in Lancaster South Carolina Description The Fraud and Waste Professional 2 conducts investigations of allegations of fraudulent ..
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 ..
Job Information Humana Special Investigations Professional / Lab Investigator (Fraud, Waste & Abuse) Remote/Virtual in US in Lancaster South Carolina Description The Fraud and Waste Professional 2 conducts investigations of allegations ..
Loan Administration Quality Assurance Specialist Position Summary Provide direction and coordination of all activities for the Loan Administration functions specific to review, research, and audit of documents/files as required for Loan ..
... with experience in business process, regulatory, or compliance audits and/or business ... compliance audits and/or business process, regulatory, or advisory/consulting service. Certified Anti-Money ... advisory/consulting service. Certified Anti-Money Laundering..
Description 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 or data requires ..
Position Overview: The Bankruptcy Oversight Specialist is responsible for handling all activities related to the bankruptcy action in accordance with statutory compliance, regulatory compliance, and company guidelines. This position is responsible ..
Position Summary The Foreclosure Oversight Specialist is responsible for monitoring and completing all activities related to the foreclosure action in accordance with statutory compliance, regulatory compliance, and company guidelines. This position ..
Job Description Health is everything. At CVS Health we are committed to increasing access, lowering costs and improving quality of care. Millions of times a day, we're helping people on their ..
... and data monitoring. The Insurance Specialist directly impacts the quality of ... insurance claims in-house. The Insurance Specialist monitors quality and accuracy of ... progress to completion. The Insurance..
Description The Compliance Lead ensures compliance with governmental requirements. The Compliance Lead works on problems of diverse scope and complexity ranging from moderate to substantial. This role will focus on Humana's ..
Description The Lead, IT Compliance assesses the most complex new and existing information systems applications to ensure that appropriate controls exist, that processing is efficient and accurate, and that information systems ..
