- Molina Healthcare (Augusta, GA)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... evidence-based guidelines. + Experience in Utilization/Quality Program management + HMO/Managed care experience **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** Board Certification (Primary Care preferred). **PHYSICAL DEMANDS:** Working environment is… more
- Humana (Atlanta, GA)
- …reporting on progress, challenges, and achievements to management. + Partner with Medicare Risk Adjustment (MRA) and vendors to establish data feeds for STARs ... data and maximize the quality of the data procured digitally and manually. + Support STARs Clinical Team to gather data for pilots and Humana acquisitions. + Submit FTP requests, approve UAT and postproduction, and partner on most aspects of data acquisition… 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 ... environment/managed care **Additional Information** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download… more
- Wolters Kluwer (Atlanta, GA)
- …space either in payer, provider, or vendor. + Experience working with risk adjustment software. + Strategic Communication: Advanced communication skills for ... high-level interactions. + Leadership: Ability to lead and mentor junior team members. + Deep Product Knowledge: In-depth understanding of the organization's products or services. + Sales Strategy: Proficient in complex sales strategy development and… more
- RELX INC (Alpharetta, GA)
- About the Business: LexisNexis Risk Solutions is the essential partner in the assessment of risk . Within our Business Services vertical, we offer a multitude of ... Laundering/Counter Terrorist Financing, Identity Authentication & Verification, Fraud and Credit Risk mitigation and Customer Data Management. You can learn more… more
- RELX INC (Atlanta, GA)
- About the Business LexisNexis Risk Solutions is the essential partner in the assessment of risk . Within our Government vertical, our solutions assist government ... informed decisions to enhance investigations. You can learn more about LexisNexis Risk at the link below. https:// risk .lexisnexis.com/government About our Team… more
- BrandSafway (Atlanta, GA)
- …Internal Audit to manage the audit process for assigned audits, including risk assessment, planning, audit execution and reporting results, including: + Collaborate ... leadership to identify and evaluate risks and drive a risk -based audit approach. + Identify systemic root causes from...the next, to assist with end-to-end remediation and strategic adjustment . + Act as a trusted advisor to the… more
- RELX INC (Atlanta, GA)
- About the Business: LexisNexis Risk Solutions is the essential partner in the assessment of risk . Within our Business Services vertical, we offer a multitude of ... Laundering/Counter Terrorist Financing, Identity Authentication & Verification, Fraud and Credit Risk mitigation and Customer Data Management. You can learn more… more
- RELX INC (Atlanta, GA)
- About the Business: LexisNexis Risk Solutions is the essential partner in the assessment of risk . Within our Business Services vertical, we offer a multitude of ... Laundering/Counter Terrorist Financing, Identity Authentication & Verification, Fraud and Credit Risk mitigation and Customer Data Management. You can learn more… more
- AIG (Atlanta, GA)
- …stakeholder reporting requirements including critical identification of loss trends and risk management opportunities. You will be required to develop talent from ... + Consistently review existing best practice guidelines and claim adjustment procedures in conjunction with the Head of NA...and report NA Aerospace claim trends, lessons learned and risk management opportunities to the Head of NA Aerospace… more