- Humana (Boston, MA)
- …of our caring community and help us put health first** The RN , Compliance Nurse 2, Quality Assurance Auditor reviews utilization management activities ... to prevent and detect fraud, waste, and abuse. The RN , Compliance Nurse 2, Quality Assurance Auditor ensures mandatory reporting is completed. Conducts… more
- Molina Healthcare (Cambridge, MA)
- …Nursing License ( RN may be preferred for specific roles) + Certified HEDIS Compliance Auditor (CHCA) To all current Molina employees: If you are interested ... provides direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities. **The focus of this position will be member outreach… more
- Commonwealth Care Alliance (Boston, MA)
- …Program + Contribute towards the maintenance and enhancement of an effective Compliance Monitoring Program + Contribute towards the maintenance and enhancement of an ... effective Compliance Risk Assessment Program + Project manage regulator and...capacity by serving as point of contact for external auditor /reviewer, exhibiting the highest level of professionalism and courtesy.… more
- Commonwealth Care Alliance (Boston, MA)
- …under the direction of the Sr. Director, TPA Management and Claims Compliance , Healthcare Medical Claims Coding Sr. Analyst will be responsible for developing ... Coder (CPC) + Certified Inpatient Coder (CIC) + Certified Professional Medical Auditor (CPMA) **Desired Education (nice to have):** + Masters Degree Required… more