- Evolent (Columbus, OH)
- …system processing in detail + provide summary information to stakeholders & management answering business questions + create & maintain queries supporting precise ... test execution + Consult with the manage and report risk , issues, and decisions with the lead / manager...Knowledge of Medicare, Medicaid, Commercial Plans and understanding on claims workflow, members, providers + A minimum of 1… more
- Molina Healthcare (Akron, OH)
- …laws and regulations, which will protect the Business from liability and potential risk . Ensures that the Business understands and complies with applicable laws and ... building regulatory compliance audit procedures. * At the direction of management , coordinates and performs oversight audits and validation activities to ensure… more
- Molina Healthcare (OH)
- …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
- Stantec (Cleveland, OH)
- …optimize critical paths, perform total float analysis, correlate schedule, cost, and risk assessments, and periodically report the project management status of ... from concept to completion. We partner with clients to provide both program management and construction management to strategize, plan, and implement projects… more
- Prime Therapeutics (Columbus, OH)
- …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
- ARCO (Cincinnati, OH)
- …drafting and negotiating? Do you want to better understand the business considerations that inform risk management decisions? Are you looking to be a part of a ... experience in transactional practice or combination of transactional and construction litigation/ claims management is preferred + Experience leading negotiations… more
- ZOLL Medical Corporation (Columbus, OH)
- …trusted to protect more than 1M patients at risk of sudden cardiac death. + HFMS (https://cardiacdiagnostics.zoll.com/products/heart-failure-arrhythmia- management ... patients suffering from serious cardiopulmonary and respiratory conditions.ZOLL Cardiac Management Solutions offers a unique portfolio of novel technologies designed… more
- CVS Health (Columbus, OH)
- …work with a collaborative, close-knit team on pharmacy and member specific claims data including, but not limited to, financial and operational information ... activities, tracking completion of action items, resolving issues, and mitigating risk + Champion a culture of continuous improvement, curiosity, collaboration, and… more
- BrightSpring Health Services (Clayton, OH)
- …unemployment claims for assigned service site(s). Is proactive in efforts to reduce claims and minimize risk /exposure of agency in these areas + Other duties ... be substituted per area regulations. Exceptions must have written approval from Regional Management + A minimum of two years of verifiable work experience providing… more
- Humana (Columbus, OH)
- …to assess, investigate, audit and validate the mitigation of compliance risk across the organization. This team ensures that healthcare providers align ... and internal controls, and communicating issues and recommendations to management . Coordinates implementation and compliance with corrective action plans.… more