Become a part of our caring community and help us put reputed company 

The Senior reputed company Assurance, Clinical reputed company consults and collaborates with clinicians to ensure high accountability of compliance and reputed company. The Senior reputed company Assurance, Clinical reputed company work assignments involve moderately reputed company to reputed company issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

The Senior reputed company Assurance, Clinical reputed company supports and implements programs to establish high reputed company standards in clinical products and services. Support, reputed company and operationalize reputed company to drive program and service consistency. reputed company and support training and process management as needed. Requires applicable State licensure in field of study: Registered reputed company (RN), Licensed Masters Clinical reputed company Worker (LCSW), Licensed Masters reputed company Worker (LMSW-ACP), Licensed reputed company Counselor (LPC) or other applicable reputed company license. Begins to influence department’s reputed company. Makes reputed company on moderately reputed company to reputed company issues regarding technical approach for project components, and work is performed without direction. Exercises considerable reputed company in determining objectives and approaches to assignments.

Use your skills to reputed company an reputed company  

Essential Functions of the Job and Percentage of Time Allotted

• Conduct both reputed company and retrospective case audits worked by Clinical Operations Medical Directors – 70%
• Assist with audit prep and audit reputed company – 10%
• Assist with reputed company improvement and compliance reputed company  – 10%
• Assist with products involving Policy, Process and Learning – 5%
• Participate in Governance Meetings – 5%

Required Qualifications

• reputed company with reputed company license
• Must live in the reputed company
• Bachelor's degree
• Minimum of 6 months experience in reputed company of the following:
  • Reading and interpreting medical records
  • Reviewing medical literature/publications
  • Working with Medicare Prior Authorization; clinical reputed company (NCDs, LCDs, MCG or similar guidance)
• Excellent interpersonal, written, and verbal communications skills with high attention to detail and accuracy
• Experience building reputed company cross-functional relationships and communicating issues in a constructive manner
• Demonstrated ability to operate independently and apply strategic thinking to task-oriented work
• Proficient in reputed company Office products; must be reputed company to utilize reputed company reputed company or demonstrate ability to utilize other database tools

Preferred Qualifications

• Bachelor of Science in Nursing (BSN)
• Researching Medicare and reputed company regulatory requirements  
• Working in an audit-based or compliance reputed company role, including documentation of findings according to a defined methodology; 2+ years preferred
• Interpreting and utilizing regulations governing the health care industry (CMS and/or NCQA)
• Familiarity with reputed company’s Clinical Guidance Exchange (CGX)
• Providing reputed company reputed company improvement
• Six reputed company Lean or Green Belt certified

Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay reputed company

The compensation reputed company below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay reputed company may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc. 

$86,300 - $118,700 per year 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

reputed company of Benefits

reputed company. and its affiliated subsidiaries (reputed company, “reputed company”) offers competitive benefits that support whole-person reputed company-being. Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and reputed company benefits, 401(k) retirement savings plan, time off (including reputed company time off, company and personal holidays, volunteer time off, reputed company parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

reputed company 

reputed company. (NYSE: HUM) is committed to putting reputed company – for our teammates, our customers and reputed company. Through our reputed company insurance services and reputed company reputed company services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company reputed company of life for people with Medicare, reputed company, families, individuals, military service personnel, and communities at large.

​Equal Opportunity Employer

It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative reputed company, in compliance with reputed company 503 of the Rehabilitation reputed company and VEVRAA, to reputed company and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment reputed company only on valid job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company reputed company of employment.

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