- Otsuka America Pharmaceutical Inc. (Nashville, TN)
- …Must demonstrate a high level of understanding of regulations related to promotion compliance . May be assigned additional responsibilities as deemed necessary. ... Must demonstrate a high level of understanding of regulations related to promotion compliance . May be assigned additional responsibilities as deemed necessary.… more
- Vanderbilt University Medical Center (Nashville, TN)
- …care, education, and research. **Organization:** Quality Admin **Job Summary:** The Associate Director supervises, coordinates and monitors the work activity ... . The VUMC Quality Administration Laboratory Department is in need of a ** Associate Director ** to join the team! **Department Summary:** Our new… more
- Humana (Nashville, TN)
- …a part of our caring community and help us put health first** The Associate Director , Business Systems Analysis performs analysis of business, process and user ... cost/benefit analysis and translation into proper system requirement specifications. The Associate Director , Business Systems Analysis requires a solid… more
- Humana (Nashville, TN)
- …a part of our caring community and help us put health first** The Associate Director , Software Engineering leads software development application team based on ... business requirements. The Associate Director , Software Engineering requires a solid...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (Nashville, TN)
- …Description Humana's Insurance IT organization is seeking an experienced and strategic Associate Director , Technology Solutions to lead technology efforts within ... processes, and enterprise data management is highly preferred. The Associate Director , Technology Solutions acts as a...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Otsuka America Pharmaceutical Inc. (Nashville, TN)
- The Associate Director , Channel Analytics will be a key member of the Business Analysis team, responsible for leading marketing mix and channel analytics to ... of promotional investments across various channels (HCP, DTC, digital, non-personal promotion , etc.). + Develop and refine multi-touch attribution models and other… more
- CenterWell (Nashville, TN)
- …training program for coding staff to ensure continuous skill development and compliance with coding standards. + Partner with analytics and audit to identify ... coder errors and develop plans to address deficiencies/specific areas of focus. ** Associate Engagement and Retention:** + Develop and implement strategies to foster… more
- Humana (Nashville, TN)
- …part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home ... health, DME, skilled nursing facility and waiver requests. The Medical Director provides medical interpretation and determinations whether services provided by other… more
- Humana (Nashville, TN)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national… more
- Humana (Nashville, TN)
- …a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The Medical Director ... or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make… more
- Humana (Nashville, TN)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... at the Inpatient level. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national clinical… more
- Humana (Nashville, TN)
- …community and help us put health first** The Utilization Management (UM) Director , Clinical Strategy and Practice for Medicaid builds strategies for development, ... clinical practices and processes for clinical community within the enterprise. The Director , Clinical Strategy and Practice requires an in-depth understanding of how… more
- Humana (Nashville, TN)
- …our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. ... The Corporate Medical Director works on problems of diverse scope and complexity...necessity of services provided by other healthcare professionals in compliance with coverage policies, procedures, and performance standards. CMD… more
- Humana (Nashville, TN)
- …experience for our associates, members and providers. As the Resolution Team Operations Director ( Director , Grievance and Appeals), you will be accountable for ... and/or other end compliant inquiries. + Has 6-7 direct reports including Associate Directors, Managers, and Senior Professionals + Provides strategic direction and… more
- Humana (Nashville, TN)
- …of our caring community and help us put health first** The Director , Risk Adjustment Strategy Advancement will provide business intelligence and strategic planning ... support for business segments and the company at large. The Director , Risk Adjustment Strategy Advancement requires an in-depth understanding of how organization… more
- CenterWell (Nashville, TN)
- …a part of our caring community and help us put health first** The Director , Account Management is responsible for growing membership within existing accounts and for ... directly managing business relationships with client accounts. The Director , Account Management requires an in-depth understanding of how organization capabilities… more
- Humana (Nashville, TN)
- …business partners to uphold ethical standards and mitigate risks. The Senior Clinical Compliance Professional will support the Director of Compliance , by ... about 340+ senior focused primary care centers in 15 states. The Regulatory Compliance team that supports the PCO is responsibility to assess, investigate, audit and… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Payment Compliance Billing Specialist I is responsible for processing, auditing, and submitting primary and secondary insurance claims, ensuring ... accuracy, compliance , and timely reimbursement. This role utilizes electronic claims...standards. **Qualifications** + HS Diploma or GED required + Associate Degree in Business, Healthcare Administration, Medical Billing, or… more
- Community Health Systems (Franklin, TN)
- …billing information. Complies with all policies and procedures of the Corporate Compliance Program. Reports Noncompliance issues detected to the department Manager, ... Director and/or the Senior Director of Physician...standards. **Qualifications** + HS Diploma or GED required + Associate Degree in Health Information Management or related field… more
- CenterWell (Nashville, TN)
- …professional and personal lives. We promote lifelong well-being by giving our associate fresh perspective, new insights, and exciting opportunities to grow their ... and lead with the care team through daily huddles. . Helps Regional Medical Director (RMD), Physician and Center Administrator in setting a tone of cooperation in… more