Regulatory Specialist Jobs in South Dakota

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 Fraud and Waste Professional 2 conducts investigations of allegations of fraudulent and abusive practices. The Fraud and Waste Professional 2 work assignments are varied and frequently require interpretation and ..

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 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 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 ..

Complex Claims Specialist - Program Law Duties: The candidate performs a combination of duties in accordance with departmental guidelines. Manages an inventory of moderate to high complexity and exposure commercial claims ..

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

Compliance Associate needed! A growing banking/trust company is looking to add a Compliance professional to their team! You will directly with the Head of Operations Compliance to ensure goals are being ..

Compliance Associate needed! A growing banking/trust company is looking to add a Compliance professional to their team! You will directly with the Head of Operations Compliance to ensure goals are being ..

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, UM Administration contributes to administration of utilization management. The Supervisor, UM Administration works within thorough, prescribed guidelines and procedures; uses independent judgment requiring analysis of variable factors to ..

Description Be a part of the Software Asset Management (SAM) team reporting directly to the Humana Software Asset Management Licensing Lead. Humana is seeking a Software Entitlement and Compliance Specialist who ..

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 Aberdeen South Dakota Description The Fraud and Waste Professional 2 conducts investigations of allegations ..

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..

... business requirements, provide research and regulatory interpretation, and advise internal business ... monitor performance; Interpret and define regulatory and contract requirements to be ... set of data relating to..

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 Humana is seeking a Software Entitlement and Compliance Specialist who will be accountable for partnering with specific business areas to support both hardware and software asset management processes including full ..

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 (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) ..

... 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..

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 ..