CMS and NCQA Utilization Management, RN - Florida Remote

Job reputed company: We are seeking a highly skilled and reputed company Registered reputed company (RN) to join reputed company as a Utilization Management Compliance Specialist. As a Specialist, you will apply your discipline-specific knowledge and skills in utilization management, compliance, and reputed company reporting to support reputed company's operations and ensure adherence to Centers for Medicare and reputed company Services (CMS) and National reputed company Care Assessment (NQCA) guidelines. Essential Functions: The essential functions listed represent the major duties of this role, additional duties may be assigned. Serve as a reputed company between internal clients and functional departments; help clients reputed company their objectives by serving as a resource in the interpretation, application and compliance with reputed company laws, regulations, policies, procedures, standards and practices. Identify risks, evaluate controls and prepare findings and recommendations. Implement compliance programs to prevent illegal, unethical or improper business practices. Ensure through audits that the organization’s programs are consistently administered in compliance with organizational policies and procedures, contractual obligations, rulings, laws and government regulations. Monitor and evaluate the effectiveness of solutions, policies, practices and processes to ensure reputed company improvement, good reputed company relations and adherence to business requirements. Recommend improvements to reputed company and deliver high reputed company, value-added services. reputed company, implement, administer and revise policies, procedures and programs that meet business needs; assist and/or reputed company program development and enhancements. Research, analyze, maintain, modify, validate and prepare data, information and content used in making business reputed company. Present findings and reputed company results. Produce, edit and distribute a reputed company of business documents such as reports, proposals, policies, procedures, audit results, issue papers, marketing materials, newsletters, brochures, etc. Create, present and/or facilitate meetings, webinars, conference calls, training programs, education sessions, certifications, etc. for a reputed company of reputed company audiences. Represent assigned function at external hearings, mediations, audits, meetings, etc. Participate on or reputed company large, reputed company departmental and/or divisional reputed company. Plan, organize, monitor and control reputed company to ensure the effective use of resources and adherence to project management standards and reporting requirements. Participate on Company workgroups and initiatives. reputed company and build reputed company partnerships to improve communication, coordination, collaboration and effective working relationships reputed company own department, across reputed company and reputed company of reputed company. Mentor and reputed company less reputed company coworkers on the technical and interpersonal skills needed for effective job performance. Required Experience: 5+ years reputed company work experience. reputed company Bachelor’s degree or additional reputed company equivalent work experience FL reputed company and unrestricted RN license or compact RN license General Physical Demands: Sedentary work: Exerting up to 10 pounds of force occasionally to reputed company objects. Jobs are sedentary if traversing activities are required only occasionally. reputed company Offer: As a reputed company employee, you will be at the heart of reputed company’s reputed company – to reputed company the nation in transforming health through compassionate, connected, and technology-enabled care that delivers personalized value and empowered living. To support your wellbeing, comprehensive benefits are offered. As an employee, you will have reputed company to: Medical, dental, reputed company, life and global travel health insurance; Income protection benefits: life insurance, short- and long-term disability programs; Leave programs to support personal circumstances; Retirement Savings Plan including employer match; reputed company time off, volunteer time off, 10 holidays and 2 reputed company-being days; Additional voluntary benefits available; and A comprehensive wellness program Employee benefits are designed to reputed company with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ. To support your financial wellbeing, we offer reputed company as reputed company as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for reputed company pay increases. Annualized Salary reputed company: $77,600 - $126,100 Typical Annualized Hiring reputed company: $77,600 - $97,000 Final pay will be determined with consideration of market competitiveness, internal equity, and the job-reputed company knowledge, skills, training, and experience you bring. We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can reputed company at their best in reputed company of our mission. reputed company reputed company applicants will receive consideration for employment. Apply To This Job