Regulatory Policy Specialist Jobs in Troy

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 ..

Job Information Humana Pharmacy Special Investigations Professional (Fraud, Waste & Abuse) Remote in US in Troy Michigan Description The Fraud and Waste Professional 2 conducts investigations of allegations of fraudulent and ..

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 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 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 ..

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

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 ..

Legal Counsel - Bank Regulatory and Treasury Services Duties: The candidate will work extensively with the team to provide comprehensive support, advice and guidance on the ever-evolving legal and regulatory landscape ..

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

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

Principal Compliance Specialist, Corporate Functions and Payment Duties: ... assists with the research of regulatory compliance requirements and evaluating the ... business in operationalizing legal and regulatory requirements inherent in..

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 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 ..

Principal Compliance Specialist The candidate maintains and enhances department or functional units in support of the overall compliance program components. Assists with researching regulatory compliance requirements and evaluating the adequacy of ..

Job Information Humana Special Investigations Professional / Lab Investigator (Fraud, Waste & Abuse) Remote/Virtual in US in Troy Michigan Description The Fraud and Waste Professional 2 conducts investigations of allegations of ..

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 ..

Job Information Humana UM Medical Director - Conviva in Troy Michigan Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..

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, ..

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