• Medical Director (Marketplace)

    Molina Healthcare (Dayton, OH)
    …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred… more
    Molina Healthcare (06/29/25)
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  • Sr Compliance RCM & Coding Auditor

    Humana (Columbus, OH)
    …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 (07/29/25)
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  • Senior Analyst, Medical Economics - REMOTE

    Molina Healthcare (Columbus, OH)
    …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... performance is achieving desired results + Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare **Job Qualifications** **Required… more
    Molina Healthcare (07/10/25)
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