- Humana (Providence, RI)
- …and regulations across Humana Specialty and Military products. The Director manages dedicated compliance teams of associates who oversee compliance ... Compliance to develop and implement compliance programs for Humana's Specialty and Military products and contracts. The Director is responsible for … more
- Humana (Providence, RI)
- …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 (Providence, RI)
- …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 (Providence, RI)
- …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 (Providence, RI)
- …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 (Providence, RI)
- …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 (Providence, RI)
- …our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The ... Corporate Medical Director works on problems of diverse scope and complexity...appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents… more
- Citizens (Johnston, RI)
- …risks through the identification, management and mitigation of the risk and compliance control environment. The incumbent will serve as a liaison, interfacing with ... analyzing, and identifying emerging risks, escalating to the Senior Director / Director of First Line Risk where...assessed, documented, and implemented. You will work closely with Compliance officers to ensure that your team is up… more
- Sodexo (Providence, RI)
- …Rhode Island, a Care New England hospital, is one of the nation's leading specialty hospitals for women and newborns. The major teaching affiliate of The Warren ... with the Environment of Care Committee and Infection Prevention Director + effectively manages the Unit Operating System +...leadership skills and can work independently to drive program compliance and reach project target dates of completion +… more
- Sodexo (Needham, MA)
- …that brings together academic medical centers and teaching hospitals, community and specialty hospitals, and more than 4,700 physicians and 39,000 employees in a ... department; + work with the Environment of Care Committee and Infection Prevention Director ; + effectively manages the Unit Operating System; and/or + support a… more