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... with DOI (Department of Insurance) regulatory and compliance requests Bachelor's degree and 5 ... degree and 5 years of healthcare regulatory experience 2 years of project ... creating analytics..
... Information Humana Medicaid Associate Director, Compliance Nursing in Dover Delaware Description ... Delaware Description The Associate Director, Compliance Nursing reviews utilization management activities ... and abuse. The Associate Director,..
Description The Director, Strategy Advancement provides data-based strategic direction identifying and delivering new avenues of growth is a critical company priority, championed by the SVP of Retail Strategy & Product. We're ..
... whether services provided by other healthcare professionals are in agreement with ... of services provided by other healthcare professionals in compliance with review policies, procedures, and ... occurs with..
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..
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..
... occurs within a context of regulatory compliance, and work is assisted by ... whether services provided by other healthcare professionals are in agreement with ... meeting departmental expectations, and..
Description The Senior Pre-Authorization Nurse reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. Makes decisions on ..
POSITION FEATURES:*12 weeks of PAID training, no experience required*Competitive pay*Pay increase when certified (required within 18 months)*No Sundays, e/o Saturday*Tuition reimbursementDescriptionProvide your personal attention and kindness, professional insight, and a generosity ..
... in Dover Delaware Description The Healthcare Quality Reporting & Improvement (HQRI) ... guidance to ensure physician and healthcare provider plans, education, reporting and ... regional strategies for physician and..
Description The Manager, 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 Manager, Compliance ..
Description Humana is seeking a Senior Communications and Marketing Professional to join our growing team. The Senior Communications and Marketing Professional will create and lead strategy for Humana's Wisconsin Medicaid Market ..
Description The Compliance Nurse 2 reviews utilization management ... fraud, waste, and abuse. The Compliance Nurse 2 work assignments are ... appropriate courses of action. The Compliance Nurse 2 will..
... Remote Telephonic RN Opportunity The Compliance Nurse reviews utilization management activities ... fraud, waste, and abuse. The Compliance Nurse work assignments are varied ... schedule and overtime. Responsibilities The..
Description The Pharmacy Claims Lead operationalizes and monitors Coordination of Benefits (COB) and subrogation claim processing logic and processes. Exercises independent judgment and decision making on managing staff, complex issues regarding ..
... Update as process change for compliance and oversight of appropriate materials ... requirements for company, quality, and regulatory compliance. Analyzes course evaluations in order ... 1 or more years..
... Information Humana Senior Insurance Product Compliance Professional in Dover Delaware Description ... Description The Senior Insurance Product Compliance Professional Performs consultation and research ... development. The Senior Insurance Product..
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 Parity Compliance Lead will play an integral ... of our Mental Health Parity Compliance Program. Responsibilities This role is ... monitoring all related behavioral health regulatory..
... occurs within a context of regulatory compliance, and work is assisted by ... of services provided by other healthcare professionals in compliance with review policies, procedures, and ... whether..
