- Molina Healthcare (Austin, TX)
- **JOB DESCRIPTION** **Job Summary** Responsible for Medicare risk adjustment related estimates, establishing premium rates, financial analysis, and reporting. ... Extracts, analyzes, and synthesizes data from various sources to identify risks. Maintain/update SQL model(s), estimate risk scores, and analyze impact. **KNOWLEDGE/SKILLS/ABILITIES** + Collaborate with Actuarial staff to calculate risk adjustment payment… more
- Molina Healthcare (San Antonio, TX)
- …License without restrictions (free of sanctions from Medicaid or Medicare ) **PREFERRED EDUCATION:** Master's in Business Administration, Public Health, Healthcare ... Administration, etc. **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** Board Certification (Pediatrics, Family Practice, Ob/Gyn or Internal Medicine). **PHYSICAL DEMANDS:** Working environment is generally favorable and lighting and temperature are adequate.… more
- Molina Healthcare (San Antonio, TX)
- …**Job Summary** Responsible for the Management of internal business projects and programs involving department or cross-functional teams of subject matter experts, ... delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs, and monitors… more
- Molina Healthcare (Dallas, TX)
- …**Job Summary** Responsible for accurate and timely measurement of critical provider analytics including Network Adequacy and other critical metrics. Synchronizes ... data among multiple systems to ensure accurate reporting of the Provider Network across the enterprise. Validate data on provider databases and ensure adherence to business, system and regulatory requirements of Provider Data Management/Network Adequacy.… more
- CVS Health (Austin, TX)
- …Aetna, a CVS Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We ... At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans… more
- Molina Healthcare (Houston, TX)
- …**Job Summary** Establish a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and regulations, which will ... protect the Business from liability of fraudulent or abusive practices. Ensures that the Business understands and complies with applicable laws and regulations pertaining to the Health Care environment. Ensures the Business' accountability for compliance by… more
- Molina Healthcare (Houston, TX)
- …**Job Summary** Leads business process improvement initiatives that result in operational efficiencies and/or an increase in customer satisfaction. Assists in ... development of MHI's business process improvement methodology and in the implementation of a business process improvement capability. **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for most complex process analysis, design, and simulation. + Requires highest… more
- CVS Health (Austin, TX)
- …**Work Schedule: Start times between 7:50 am and 11:45 am EST** The Worklife Resource Consultant is part of the Worklife Team and provides education about community ... resources, resource needs assessment, and community and/or national referrals to a variety of customers for a variety of needs including childcare, elder/adult care, and basic/everyday needs. The WLC is responsible for providing Worklife consultation and… more
- Humana (Austin, TX)
- …health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve ... analysis of situations or data requires a case-by-case consideration of the Medicare rules, Humana policies and medical necessity. The Medical Director's work… more
- UTMB Health (Galveston, TX)
- …calculations and estimates and ensures UTMB compliance with Medicare and Medicaid regulations. **Scope:** Institutional **Responsibilities:** + Responsible ... for technical aspects, calculations and analyses of multiple areas of Medicare and Medicaid reimbursement components including, but not limited to, cost report… more