- Centene Corporation (Tallahassee, FL)
- …remote from home anywhere in the Continental United States.** **Position Purpose:** Supports the Risk Adjustment Compliance program elements, with a focus on ... , Legal or related field; or equivalent experience required + 3+ years Audit, risk adjustment and/or compliance required + Previous experience in risk … more
- Citigroup (Tampa, FL)
- …that contribute to the definition of the Enterprise Data Governance Strategy, and/or Data Risk and Control Framework and Data Risk Taxonomy, and plays a critical ... role in leading activities to support implementation of the Data Governance Policy/Data Risk and Control framework. The role will play a critical leadership role in… more
- Citigroup (Tampa, FL)
- …will lead a key execution component of a critical program focused on Adjustment Reduction and Data Automation, directly tied to key regulatory concerns. This ... to effectively manage relationships with internal audit, central Transformation teams and senior leadership across Data, Technology, and second and third lines of… more
- CVS Health (FL)
- …the Centers of Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical ... and/or auditing. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) required.… more
- Citigroup (Tampa, FL)
- The Data Governance Foundation Senior Analyst - C12 is responsible for contributing to the directional strategy and implementation of the Enterprise and Wholesale ... Loans Data Governance Strategy, Data Risk and Control Framework, and plays a critical role...exception management, product development / tooling, quality control and adjustment reduction. This role requires someone who is dynamic,… more
- RELX INC (Boca Raton, FL)
- About the Business: LexisNexis Risk Solutions is the essential partner in the assessment of risk . Within our Business Services vertical, we offer a multitude of ... Laundering/Counter Terrorist Financing, Identity Authentication & Verification, Fraud and Credit Risk mitigation and Customer Data Management. You can learn more… more
- Bristol Myers Squibb (Tampa, FL)
- …work and in their personal lives. Read more: careers.bms.com/working-with-us . The Senior Manager, Project Contracts Manager will be the primary and embedded ... with Business Partners is required to ensure flawless project executions. The Senior Manager will be responsible for advancing the existing procurement process and… more
- AdventHealth (Maitland, FL)
- …in understanding professional and facility claims and managed care concepts such as risk adjustment , capitation, FFS, DRG, APG, APCs and other payment mechanisms ... of managed care contracts and proposals, analyze fee schedules, and determine contract compliance . The Senior Medical Economics analyst must have attention to… more
- RELX INC (Boca Raton, FL)
- About the Business: LexisNexis Risk Solutions is the essential partner in the assessment of risk . Within our Business Services vertical, we offer a multitude of ... Laundering/Counter Terrorist Financing, Identity Authentication & Verification, Fraud and Credit Risk mitigation and Customer Data Management. You can learn more… more
- Aston Carter (Miami, FL)
- …and experienced Sr Internal Auditor to conduct operational, financial, and compliance audits across various business units. The role involves independently ... while supporting organizational goals. Responsibilities + Conduct operational, financial, and compliance audits in alignment with internal frameworks and policies. +… more
- Molina Healthcare (Jacksonville, FL)
- …directly with **clinicians, nurses, or case management teams** + Familiarity with risk adjustment , value-based care models, or healthcare performance metrics + ... **JOB DESCRIPTION** **JOB DESCRIPTION** **Job Summary** The ** Senior Analyst, Utilization Management** plays a critical role...Understanding of regulatory and compliance considerations (eg, HIPAA) in data handling To all… more
- Bristol Myers Squibb (Tampa, FL)
- …stakeholders** + Perform appropriate due diligence by issue spotting and assessing risk mitigating options this includes contract analysis to identify key legal ... contracts in a timely manner with appropriate legal support to ensure compliance with company standards. + Negotiate business/commercial terms to advance BMS'… more
- Travelers Insurance Company (Orlando, FL)
- …reserving, litigation management, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific ... for specific activities required to effectively evaluate claims, such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators, and other… more
- CenterWell (Daytona Beach, FL)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... initiatives *Champion our senior -focused primary care strategic vision and initiatives and foster...and coaching initiatives are precise *Identify critical issues for high- risk patients during case reviews & other forums, and… more
- CenterWell (Jacksonville, FL)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... initiatives + Champion our senior -focused primary care strategic vision and initiatives and foster...coaching initiatives are precise + Identify critical issues for high- risk patients during case reviews & other forums, and… more
- AdventHealth (Maitland, FL)
- …in understanding professional and facility claims and managed care concepts such as risk adjustment , capitation, FFS, DRG, APG, APCs and other payment mechanisms ... of managed care contracts, proposals, analyze fee schedules, and determine contract compliance . The Medical Economics Manager must have attention to detail and… more
- Florida Atlantic University (Boca Raton, FL)
- …contracts, including vendor coordination, performance monitoring, issue resolution, and compliance with scope of work and regulatory requirements. + Coordinate ... regulatory standards. + Serve as acting lead in the absence of the Senior Director, when assigned. + Serve as Essential Personnel. Design, Construction and Capital… more
- L3Harris (Palm Bay, FL)
- …services subcontracts. + Experience in supplier negotiations, subcontractor performance and risk management. + Demonstrated Experience with senior leadership ... off Job Description: L3Harris Technologies is looking for a senior level subcontracts manager/supply chain professional to help lead...time & material, labor hour, etc.) to best manage risk for both L3Harris and our customer. In addition… more
- RELX INC (Boca Raton, FL)
- About the Business LexisNexis Risk Solutions is the essential partner in the assessment of risk . Within our Business Services vertical, we offer a multitude of ... Laundering/Counter Terrorist Financing, Identity Authentication & Verification, Fraud and Credit Risk mitigation and Customer Data Management. You can learn more… more
- Molina Healthcare (Orlando, FL)
- …+ Coordinates accountabilities between segment and markets to drive performance in network, risk adjustment , and stars; single point of contact for escalations ... overall mission, core values, and strategic plan and in compliance with all relevant federal, state, and local regulatory...including service level agreements. + Works with staff and senior management to mitigate risk and develop/implement… more