• Medical Director

    Molina Healthcare (Orlando, FL)
    …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare ,… more
    Molina Healthcare (08/20/25)
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  • Associate Medical Director

    CenterWell (Jacksonville, FL)
    …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... and help us put health first** The Associate Medical Director (AMD) is an instrumental clinical leader of our...coaching initiatives are precise + Identify critical issues for high- risk patients during case reviews & other forums, and… more
    CenterWell (07/22/25)
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  • Associate Medical Director

    CenterWell (Daytona Beach, FL)
    …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... and help us put health first** Job Description Summary The Associate Medical Director (AMD) is an instrumental clinical leader of our primary care team, combining… more
    CenterWell (06/12/25)
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  • Medical Director - Dsnp/MMP

    CVS Health (Tallahassee, FL)
    …treatment protocols for DSNP/MMP and other complex health populations to optimize risk adjustment , clinical quality, and care management. * Actively participate ... oversight of DSNP/MMP complex populations (Dual-Eligible Special Needs Plan / Medicare -Medicaid Plan) * Develop and lead clinical strategy and objectives for… more
    CVS Health (07/18/25)
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  • AVP, Encounters

    Molina Healthcare (Jacksonville, FL)
    …+ Extensive understanding of Medicare Advantage, ACA and Medicaid risk adjustment processes, including encounter data submission and deletion requirements ... **Job Description** **Job Summary** The AVP, Risk Adjustment Encounters is responsible for...processes that track, evaluate, and submit encounter deletions for Medicare Advantage, ACA, and Medicaid lines of business. This… more
    Molina Healthcare (08/22/25)
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  • Sr Compliance RCM & Coding Auditor

    Humana (Tallahassee, FL)
    …analyze large data sets + Knowledge of healthcare compliance, mainly primary care and risk adjustment , pharmacy knowledge a plus + Certified Coder (CPC, CRC, ... to assess, investigate, audit and validate the mitigation of compliance risk across the organization. This team ensures that healthcare providers align… more
    Humana (08/23/25)
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  • Registered Nurse RN Care Manager East

    AdventHealth (Orlando, FL)
    …under the general supervision of the Care Managment Supervisor or Manager or Director of Nursing and is responsible for patient evaluations of post-hospital needs; ... social determinants of health into transitions of care planning and applies risk mitigation interventions to meet the individual needs of each patient Identifies… more
    AdventHealth (08/15/25)
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  • Inpatient Coding Auditor Virtual

    AdventHealth (Tampa, FL)
    …Guidelines and approved coding policies and procedures. . Participates in the mortality/ risk adjustment reviews when assigned. . Assists with post-payment DRG ... coding accuracy retrospectively and concurrently as assigned by manager and/or Director . . Reviews and addresses all third party/Regulatory Agencies requests for… more
    AdventHealth (08/07/25)
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