RN Risk & Quality Auditor: CMS/NCQA Insights
Humana Inc
Humana, Inc. is seeking a Risk Management Professional 2 to lead quality audits within the CenterWell Utilization Management program, ensuring CMS and NCQA compliance. You will leverage Power BI and Power Apps to support audits, reporting, and performance monitoring, translating findings into actionable insights for leadership. The role requires deep expertise in clinical criteria and regulatory guidance, with a strong focus on data analysis, trend identification, and audit readiness from #J-18808-Ljbffr Humana Inc
$120k - $150k
...→ change-of-condition → high-risk chronic), and align with the nursing... ...tools within 24 hours; ensure CMS compliance for SNF billing... ...scope of practice standards. Quality & continuous improvement : Participate... ...times), and surface field insights to clinical ops and product...CmsRiskFull timeNight shift- ...family! Jump‑start your career as a Quality Nurse Coordinator today with... ...Vice President of Quality and Risk Management. Perform timely and... ...Upload and disseminate reports from CMS through the Hospital Quality... ...as a Registered Nurse (RN) in the state of Tennessee or a...CmsRiskFull timeTemporary workPart timeFlexible hours
- ...Summary: As the Utilization Review RN, you would be responsible for... ...Weekly deposit options More Insight of Daily Responsibilities:... ...the consistent application of CMS criteria Assesses and coordinates... ...discharge planning Identifies quality of care issues Qualifications...CmsPrivate practiceMonday to Friday
$1,974 per week
...Registered Nurse (RN) | Obstetrics/Gynecology Location: Nashville... ...women receive the highest quality care throughout their... ...infertility, miscarriage, or high-risk pregnancies. Offer guidance... ...and care planning, contributing insights into patient progress and outcomes...RiskFull timeContract workImmediate startShift workNight shift$1,974 per week
...Registered Nurse (RN) | Obstetrics/Gynecology Location: Nashville... ...women receive the highest quality care throughout their... ...infertility, miscarriage, or high-risk pregnancies. Offer guidance... ...and care planning, contributing insights into patient progress and outcomes...RiskFull timeContract workImmediate startFlexible hoursShift workNight shift- ...clinical operations and ensure clinical quality, patient safety, provider satisfaction, risk management, operational excellence... .... Adhere to established HIPAA, NCQA, URAC and any other applicable... ...Affairs in order to ensure CMS and other regulatory compliance, while...CmsRiskLocal areaWork from home
- ...performance while ensuring high-quality, compliant, and consistent... ...prevention, medication management, and risk-reduction strategies.... ...g., state nursing regulations, CMS, Joint Commission). Monitor documentation... .... Active, unrestricted RN license. Minimum of 3–5 years of...CmsRiskTemporary workWork at office
- A major film studio is seeking a Senior Internal Auditor for its Nashville location. This role involves delivering data-driven insights and conducting risk-based audits to enhance internal controls. Candidates should have at least 5 years of experience in internal audit...Risk
- ...Analyst to contribute to research and advisory services in governance, risk, compliance, and cybersecurity technologies. You will engage in building client relationships while also providing market insights and thought leadership. Ideal candidates will possess 2-3 years of...RiskFlexible hours
- ...Internal Audit to spearhead a transformational enterprise-wide audit, risk, and control strategy. The successful candidate will be a... ...public accounting firm is required, along with a strong command of CMS regulations, PCAOB standards, SEC reporting, and COSO frameworks....CmsRisk
- ...PEOPLE ESSENTIAL FUNCTIONS Interacts and communicates effectively with members of the coding team and HIM, physicians, CDMP nurses, IT, Quality Operations, Case Management, Patient Access and Business Office. Participates and provides good feedback during coding section...CmsWork at office
$27.02 - $41.85 per hour
...coding for Medicare Advantage and ACA. The job involves analyzing physician documentation and performing HCC coding in compliance with CMS guidelines. Candidates should have at least 3 years of coding experience and be certified as CPC, CRC, CCS, or RHIT. The role is...CmsRiskHourly payRemote work- Tnbankers is seeking a Compliance Analyst to support CMS administration and regulatory alignment across the Bank. The role collaborates... ...have a bachelor's degree and 3-5 years in banking compliance or risk management, strong analytical and communication skills, and proficiency...CmsRiskFull time
- ...others, building on our successes, and taking risks, we constantly raise the bar. After all,... ...complex clinical and claims data into insights that help providers improve transitions... ...patient outcomes Strong understanding of CMS reimbursement and VBC models Genuine enthusiasm...CmsRiskLocal areaRemote workFlexible hoursShift work
- ...priorities, ensuring timely and high‑quality delivery of financial insights and support. Influence decision‑... ...Provide strategic guidance on financial risks, opportunities, and long‑range... ...healthcare‑specific requirements (e.g., CMS, Joint Commission). Partner with revenue...CmsRiskContract workWork experience placement
$90k - $140k
...client needs. Escalate operational risks or issues to senior leadership as appropriate... ...corrective actions. Compliance & Quality Assurance Ensure adherence to CMS guidelines, payer rules, and... .... Assist in gathering data and insights for proposals and service improvements...CmsRiskRemote jobWork experience placementWork at office- ...Responsibilities Responsible for assisting in the administration of the Bank's CMS to ensure compliance with applicable federal and state banking... ...works closely with all departments to identify compliance risks, recommend corrective actions, and promote a culture of...CmsRiskFull timeWork at office
- ...our Compliance Program through oversight, risk assessment, and cross‑functional collaboration... ...to regulatory requirements (e.g., CMS) and contractual obligations. Drive and support... ...teams. Active, unrestricted Registered Nurse (RN) license required. Certified in Healthcare...CmsRiskWork at officeFlexible hours
- ...Regional Director of Quality Remote Position with 50% Travel Requirement Registered Nurse (RN) License Required Position Summary:... ...responsibility over all quality, risk management and patient safety... ...including national, state, CMS, Joint Commission and other agencies...CmsRiskWork experience placementRemote work
- ...ensure continuous compliance, support market expansion, and mitigate risk. This high-visibility role involves direct oversight of the... ...with a minimum of 7 years' in a leadership role. Deep knowledge of CMS supplier standards, DMEPOS accreditation, and multi-state licensing...CmsRisk
$2,073 per week
...Registered Nurse (RN) | Obstetrics/Gynecology Location: Nashville, TN Agency:... ...Description As a Travel RN in High Risk OB at TriStar Centennial Medical Center, you... ...in a facility known for its commitment to quality care. Highlights ~ Located in vibrant Nashville...RiskFull timeContract workImmediate startShift workNight shift- ...of Mental Health, The Joint Commission and CMS Best Practice Guidelines and within the... ...) Patient Assessment (Intermediate) Risk Management (Intermediate) Peer Leadership... ...increase employees' effectiveness. Ensuring High Quality: - Performs Excellent Work: Engages...CmsRiskTemporary workWork experience placementReliefDay shift
- ...Bank is seeking a Compliance Analyst to assist in administering the CMS and ensuring regulatory compliance. The role supports monitoring,... ..., and testing, partnering with all departments to identify risks and implement corrective actions. A bachelor's degree or equivalent...CmsRisk
$76k - $102k
...Initiate technician labor productivity improvements and ensure quality standards and project requirements are met Estimate service repair... ...projects Promote and ensure compliance with Safety and Risk Management protocols, including oversight of contracts, change orders...CmsRiskFull timeFor contractorsFor subcontractorLocal area- ...from initiation through completion, ensuring 4‑for‑4 performance: quality, on time, on budget, client satisfaction. Develop project scope,... ...) on multi‑disciplined projects. Experience handling risk and change management and leading teams on mid‑sized to moderately...CmsRiskContract workVisa sponsorship
- ...care according to The Joint Commission and CMS Best Practice Guidelines and within the... ...duties may be assigned. Technical Capabilities Risk Management (Intermediate): Demonstrates... ...increase employees' effectiveness. Ensuring High Quality: Performs Excellent Work: Engages...CmsRiskTemporary workWork experience placement
$1,686 per week
...Registered Nurse (RN) | Progressive Care Unit Location: Hermitage, TN Agency:... ...need for intervention. Identify potential risks and complications, such as arrhythmias,... ...in mentoring or training initiatives. Quality and Compliance: Follow all hospital protocols...RiskFull timeContract workShift workNight shift- ...determine the necessity of continued stay while ensuring compliance with CMS criteria. The role offers a competitive salary and a friendly... ..., along with excellent benefits. Interested candidates with an RN license in TN and at least 2 years of experience in Utilization...Cms
- ...Registered Nurse (RN) | Obstetrics/Gynecology Location: Nashville, TN Agency:... ...Position Job Title Travel RN – High Risk OB (Nights) Location Nashville, Tennessee... ...for excellence in patient safety and quality of care, including accreditation from The...RiskWeekly payFull timeContract workImmediate startNight shift
$70.35k - $205.8k
..., member engagement, care management, and risk adjustment. Collaborate across Accenture’... ...the regulatory environment (e.g., HIPAA, CMS). Hands-on experience using Claude or an... ...decision-based frameworks and models to drive insights. 3+ years of high value consulting...CmsRiskLocal area
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to RN Risk & Quality Auditor: CMS/NCQA Insights. Be the first to apply!


