- Molina Healthcare (St. Petersburg, FL)
- …practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk adjustment, ... regarding utilization practices, guideline usage, pharmacy utilization and effective resource management . + Develops and implements a Utilization Management … more
- Burns & McDonnell (Melbourne, FL)
- …contract administration including request for information (RFI's), submittals, change management , contract closeout, documentation, and claims mitigation. + ... control, contracts, subcontractors, suppliers, proposals, estimates, documentation turnover, client relations/ management , field staff and other duties required to execute… more
- Prime Therapeutics (Tallahassee, FL)
- …federal and state regulatory inquiries + Develop and implement litigation and risk management strategies that align with Prime's business objectives, mitigate ... risk and protect the company's brand and business +...ensure high-quality representation + Oversee Prime's Records and Information Management (RIM) program, eDiscovery platform, employment law and HR… more
- Marriott (Longboat Key, FL)
- …in maintaining required OSHA programs and statistical data. * Assists in the management of claims by ensuring proper procedures are followed and documented. ... **Schedule** Full Time **Located Remotely?** N **Position Type** Management **JOB SUMMARY** Assists the Director of Loss Prevention… more
- Healthfirst (FL)
- …with internal teams (eg, sales, customer service, compliance) to ensure seamless management of members. + Monitor ,report, and deliver updates on memberships, data ... and CMS guidelines and to ensure member satisfaction + Lead cross functional risk assessment root cause analysis activities to identify, assess and address key risks… more
- CVS Health (Tallahassee, FL)
- …review prior claims to address potential impact on current case management and eligibility status. Focus assessments and/or questionnaires are designed to use a ... impact on our members, who are enrolled in Care Management and present with a wide range of complex...(if within scope of practice), fall assessment if fall risk identified + Complete inpatient confinement calls and monitoring… more
- CVS Health (Tallahassee, FL)
- …review prior claims to address potential impact on current case management and eligibility status. Focus assessments and/or questionnaires are designed to use a ... impact on our members, who are enrolled in Care Management and present with a wide range of complex...(if within scope of practice), fall assessment if fall risk identified. - Complete inpatient confinement calls and monitoring… more
- Compass Group, North America (Orlando, FL)
- …team to identify any safety risks * Take the lead in working with the Home Office Risk Management team in responding to or managing any safety and claims ... monitoring, and settling of team members, foodborne illness, liquor liability and guest claims * Work with local OSHA, sanitation or Everclean inspectors to support… more
- Humana (Tallahassee, FL)
- …impacting approximately $300M in annual revenue. + Collaborate with peer leaders in Risk Management and Grievances & Appeals to implement best practices and ... operations for higher quality and operational efficiency. + Ensure enrollment and claims processes comply with regulatory requirements and guidelines. + Partner with… more
- Defense Contract Management Agency (Miami, FL)
- …provisions of contracts by designing, implementing, and maintaining a risk -based surveillance program and assessment plan. Identifies opportunities for process ... (unofficial are acceptable at the time of application) to support your educational claims . Or, if you are using education to qualify in lieu of specialized… more