• Medicare Risk Adjustment

    Elevance Health (Tampa, FL)
    ** Medicare Risk Adjustment Advanced Analytics Analyst** **On-Site Requirement: Hybrid 1;** **This role requires associates to be in-office 1 - 2 days per ... an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Advanced Analytics...Performs data mining and data-driven analyses to evaluate historical program performance and to inform current operating decisions. +… more
    Elevance Health (07/29/25)
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  • Medicare Risk Adjustment

    Elevance Health (Tampa, FL)
    ** Medicare Risk Adjustment Advanced...and internal partners to apply the insights to drive risk adjustment program innovation and ... an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Advanced Analytics...the right members for the right service, to measure program outcomes, and to support information-based strategic decision making.… more
    Elevance Health (07/29/25)
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  • Senior Analyst, Healthcare Analytics ( Risk

    Molina Healthcare (FL)
    …Health Plan strategic analysis and planning and coordinates across business units on Risk Adjustment Program Valuation and Strategic/Scoreable Action Items ... analytic / programming tools as needed + Reporting includes Risk Adjustment program performance metrics,...risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA… more
    Molina Healthcare (07/17/25)
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  • Senior, Compliance Risk Adjustment

    Centene Corporation (Tallahassee, FL)
    …remote from home anywhere in the Continental United States.** **Position Purpose:** Supports the Risk Adjustment Compliance program elements, with a focus on ... adjustment regulatory landscape preferred + Risk Adjustment regulatory audit experience preferred + Medicare ...additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that… more
    Centene Corporation (07/31/25)
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  • Lead Director, Medicare Actuarial Analytics…

    CVS Health (Tallahassee, FL)
    …regulatory compliance. + Serve as a subject matter expert on CMS regulations, risk adjustment , and revenue optimization. + Collaborate with internal stakeholders ... CMS Part C/D operations. + 5+ years' experience working with CMS regulations, risk adjustment methodologies, and revenue management. + 5+ years' experience… more
    CVS Health (07/01/25)
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  • Medical Director (Marketplace)

    Molina Healthcare (Orlando, FL)
    …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... and effective resource management. + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality… more
    Molina Healthcare (06/29/25)
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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 ... improvement and coaching initiatives are precise + Identify critical issues for high- risk patients during case reviews & other forums, and modeling and driving… more
    CenterWell (07/22/25)
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  • RN Care Manager

    AdventHealth (Altamonte Springs, FL)
    …out-of-pocket tuition expense) *For eligible positions* + Nursing Clinical Ladder Program *For eligible positions* + Whole Person Well-being and Mental Health ... 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 (07/31/25)
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  • Registered Nurse Care Manager

    AdventHealth (Winter Garden, FL)
    …out-of-pocket tuition expense) *For eligible positions* + Nursing Clinical Ladder Program *For eligible positions* + Whole Person Well-being and Mental Health ... Incorporates social determinants of health into transitions of care planning and applies risk mitigation interventions to meet the individual needs of each patient +… more
    AdventHealth (07/10/25)
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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 ... performance improvement and coaching initiatives are precise *Identify critical issues for high- risk patients during case reviews & other forums, and modeling and… more
    CenterWell (06/12/25)
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