- Otsuka America Pharmaceutical Inc. (Columbia, SC)
- …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
- CenterWell (Columbia, SC)
- …part of our caring community and help us put health first** The Associate Director , Clinical Strategy and Practice builds strategies for development, engagement, ... and processes for clinical community within the enterprise. The Associate Director , Clinical Strategy and Practice requires...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (Columbia, SC)
- …problems of diverse scope and complexity ranging from moderate to substantial. The Associate Director , Data Quality/Integrity will lead and manage the HEDIS ... high quality metrics, documentation, quality controls, reporting, and exceptional delivery. The Associate Director will be responsible for ensuring the team… more
- Humana (Columbia, SC)
- …us put health first** We are seeking a strategic, collaborative, and results-driven Associate Director to lead the development and execution of leadership and ... (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart… more
- CenterWell (Columbia, SC)
- …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 (Columbia, SC)
- …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 (Columbia, SC)
- …of our caring community and help us put health first** The Medical Director relies on medical background and reviews preauthorization requests for services. The ... Medical Director work assignments involve moderately complex to complex issues...authorship. Exercises independence in meeting departmental expectations, and meets compliance timelines. Supports the assigned work with respect to… more
- Humana (Columbia, SC)
- …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 Appeals/Disputes level. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national… more
- Humana (Columbia, SC)
- …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 provides medical interpretation and decisions about the appropriateness of services… more
- Humana (Columbia, SC)
- …part of our caring community and help us put health first** The Director , Consumer Experience ensures optimized interaction between Humana and its customers through ... of predictable and sustainable readiness practices, to ensure that experiences, both associate and consumer facing deliver on intended objectives. The Director ,… more
- CenterWell (Columbia, SC)
- …our caring community and help us put health first** The Divisional Director is responsible for building a strong partnership with clinical-operational divisional ... and coordinating care to reduce acute and post-acute care utilization. The Divisional Director role is a hybrid with travel requirements to facilitate and liaise… more
- Humana (Columbia, SC)
- …of our caring community and help us put health first** The Director , Strategy Advancement provides data-based strategic direction to identify and address business ... support for business segments or the company at large. The Director , Strategy Advancement requires an in-depth understanding of how organization capabilities… more
- Humana (Columbia, SC)
- …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
- CenterWell (Columbia, SC)
- …to sit on-site at our Columbia, SC branch location.** The **RN Branch Director ** is accountable for managing the day-to-day branch operations to ensure the ... following: operational efficiencies, quality of patient care, regulatory compliance , support of business development & patient base growth, achievement of key… more
- Humana (Columbia, SC)
- …of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims. 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. Exercises… more
- Humana (Columbia, SC)
- …condition management, health outcomes, patient experience, and plan operations. The Director , Stars CAHPS Improvement and Operations is responsible for overseeing ... role will focus on enhancing member experience and satisfaction, ensuring compliance with regulatory requirements, and driving strategies to improve CAHPS scores.… more
- Humana (Columbia, SC)
- …with business partners to uphold ethical standards and mitigate risks. The Senior 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
- CenterWell (Columbia, SC)
- …of Care (POC). + Monitors cases to ensure documentation is in compliance with regulatory agencies and requirements of third-party payers. Ensures final ... audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team members/attending physicians/caregivers to… more
- CenterWell (Orangeburg, SC)
- …and contributes to department in-services. + Notify physical therapist or Executive Director of any equipment failures, lack of supplies, staff or client changes, ... with education and competence to care for patients. + Promote compliance with all fiscal intermediaries and/or other third-party payors, through education,… more
- CenterWell (Columbia, SC)
- …and assisting with weekly case conferences. Refers clinical questions to Branch Director as necessary. + Maintains the client hospitalization log, including entering ... weekly schedule for productivity / geographic issues and forwards schedule to Branch Director for approval prior to distribution to staff. + Verifies visit paper… more