- Molina Healthcare (GA)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... State (TX) Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer Review, medical policy/procedure development, provider… more
- Molina Healthcare (Columbus, GA)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... to improve financial performance. * Advanced understanding of Medicaid and Medicare programs or other health care plans. * Advanced analytical work… more
- Humana (Atlanta, GA)
- …Qualifications** + Bachelors Degree + Knowledge and/or experience within the Stars Organization, Risk Adjustment and/or Provider + PMP or CAPM Certification + ... include but not limited to Intake, Charter, Governance Structure, Project Plan, Risk /Issues Tracking, etc. + Analyze project portfolio to ensure project updates,… more
- Humana (Atlanta, GA)
- …in Business Administration or a related field + PMP certification a plus + Stars, Risk Adjustment , or IHWA experience + Knowledge and experience in health care ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more