- Evolent (Tallahassee, FL)
- …insights from product strategy analyses and translating them to complex risk -based contract development, and they will partner closely with executives across ... value-based care pursuits. + Support the development of capitated risk partnerships, focusing on cost and use trends, and...and estimate Evolent's ability to reduce costs and improve quality . + Develop models to quantify and articulate value… more
- Carnival Cruise Line (Miami, FL)
- …guidelines. + **Crew Medical Claims Management** + Review crew cases of high risk and escalate to the attention of risk management and the case management ... and facilitating expedited return-to-work planning. The Manager also escalates high- risk cases, conducts care coordination and utilization reviews. Operationally,… more
- Molina Healthcare (St. Petersburg, FL)
- …and you keep complaint data synchronized across appeals & grievances, enrollment, claims , pharmacy, and quality functions. You surface systemic issues, steer ... grievances, and member communications. * Exposure to downstream domains: Enrollment, Claims , Pharmacy/PDE, Network, Stars quality metrics. * Proven record… more
- Jacobs (Fort Lauderdale, FL)
- …ideal candidate will excel in managing contract negotiations, budgeting, cost control, and risk management, ensuring the financial success of our projects. We seek a ... Collaborate closely with the Project Manager to manage cost, schedule, and risk activities, ensuring contract compliance. * Oversee and contribute to the… more
- Molina Healthcare (Jacksonville, FL)
- …the organizational health care costs for all lines of business and directly impacting Risk Revenue and Quality Compliance. Partner with VP Encounter to ensure ... **Job Description** **Job Summary** The AVP, Risk Adjustment Encounters is responsible for establishing enterprise-wide strategy, governance, and oversight of… more
- MyFlorida (Tallahassee, FL)
- …design and implement algorithms to effectively data-mine within various types of claims data utilizing a variety of software applications; compile research, data ... include, but not be limited to, the following: * Identify suspicious patterns in claims data and other sources by applying your knowledge of heath care coding… more
- Molina Healthcare (FL)
- …+ Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) + Knowledge of healthcare ... executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify early signs of trends or other… more
- Sedgwick (Tampa, FL)
- …the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating ... demands, wages and benefits, and availability. + Thoroughly reviews contested claims . + Assists as needed with submission of accommodation recommendations to… more
- Molina Healthcare (FL)
- …+ Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) + Knowledge of healthcare ... executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify early signs of trends or other… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …technology transfers to CDMOs, including documentation review, gap analysis, and risk assessment. + Provide expert technical oversight of upstream manufacturing ... and improvements post-approval. + Author and/or review technical reports, protocols, risk assessments, and relevant sections of regulatory submissions (IND, BLA,… more