- Somatus (Mclean, VA)
- …establish risk adjustment analytics such as predictive modeling for coding improvement opportunities, provider coding improvement opportunities, provider ... for risk adjustment optimization, particularly for provider and member engagement activities. + Manage processes needed to conduct at home wellness visits.… more
- LA Care Health Plan (Los Angeles, CA)
- Provider Network Account Manager III Job Category: Provider Relations Department: Provider Network Management Location: Los Angeles, CA, US, 90017 Position Type: ... to support the safety net required to achieve that purpose. Job Summary The Provider Network Account Manager III is responsible for all aspects of the LA Care (LAC)… more
- University of Washington (Seattle, WA)
- …prioritize efforts to help achieve increased efficiency, reduced costs, mitigation of risk , and increased network reliability and sustainability. Work with ... over a dozen clinics across the state); the Washington State K20 Education Network (connecting ~400 school districts); the Pacific Northwest Gigapop - the regional… more
- Centene Corporation (Harrisburg, PA)
- …Acts as a liaison between Tier II providers (large PCP groups not on risk contracts and providers with upside only incentives) and the health plan. Manages ... Network performance for assigned territory through a consultative/account management...approach. Drives provider performance improvement in the following areas: Risk /P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization,… more
- Centene Corporation (Columbia, SC)
- …between Tier III and Tier IV providers (small to medium PCP groups not on risk contracts and providers with upside only incentives) and the health plan. Manages ... Network performance for assigned territory through a consultative/account management...approach. Drives provider performance improvement in the following areas: Risk /P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization,… more
- Centene Corporation (Topeka, KS)
- …and/or those with complex contracts) and the health plan. Manages Network performance for assigned territory through a consultative/account management approach. ... Drives provider performance improvement in the following areas: Risk /P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc. Evaluates provider… more
- Tufts Medicine (Burlington, MA)
- …through extensive interaction with physicians, nursing staff, other patient caregivers, and coding staff to ensure that documentation reflects the level of service ... conditions and procedures, for accurate representation of severity of illness, expected risk of mortality, and complexity of care of the patient through extensive… more
- Walmart (Bentonville, AR)
- …or puppet) to automate repetitive tasks and releases for a more efficient workflow. Coding : Requires knowledge of: Coding standards and guidelines; Coding ... standards and tools (Eg, Monday.com, Linx, Embold etc.) for software coding /configuration. Take initiative to learn the fundamentals of different coding… more
- Walmart (Bentonville, AR)
- …assessments and infrastructure security reviews for applications and their supporting network infrastructure; and performing secure coding review. Ensure ... center processes; Major types of intrusions; Stakeholder segmentation; Cyber risk policies and standard operating procedures; Relevant data analytics tools… more
- Walmart (Bentonville, AR)
- …automation tools. Assist in identification of repetitive tasks that can be automated. Coding : Requires knowledge of: Coding standards and guidelines; Coding ... Emerging tools and technologies; Telemetry. To adhere to all relevant coding guidelines (Ex: code review processes, code branching strategies, reusability etc.)… more
- Walmart (Bentonville, AR)
- …IF YOU ARE INTERESTED IN A SUMMER 2025 INTERNSHIP, REQS WILL OPEN SOON** Coding : Requires knowledge of: Coding standards and guidelines; Coding languages ... SDLC; Secure SDL frameworks and tools To adhere to all relevant coding guidelines (Ex: code review processes, code branching strategies, reusability etc.) while… more
- Walmart (Bentonville, AR)
- …Risk frameworks and methodologies; Security testing techniques; Secure coding frameworks and standards; Scripting; Operating systems; Networking; Mobile ... Security standards, frameworks, and methodologies (System Security Plan -SSP, Security Risk and Compliance Review- SRCR etc.); Cloud, Platform, IoT and New… more
- Capital One (Mclean, VA)
- …and necessary updates. Lead continuous monitoring activities and updates to risk assessments, audit universe, and audit plan.** + **Oversee multiple, concurrent ... IT Operations, and Cloud audits across assigned portfolios.** + **Develop engagement planning documentation and audit programs to ensure adequate coverage of… more
- Highmark Health (Wilmington, DE)
- …including its drivers in disease-based management, care management, utilization management, and risk coding opportunities as well as pharmacy strategies. + ... performance improvement. Accountable for meeting targets in areas of Risk Revenue, Quality/stars, affordability, reimbursement/contracting trend, network … more
- ZOLL Medical Corporation (Broomfield, CO)
- …design, configure, test, implement, maintain and support ZOLL's computer and network security infrastructure. The Security Architect is responsive to changes in ... regulations and risk and works proactively to anticipate both regulatory changes...structures to protect the company's systems.Essential Functions + Lead engagement with IT stakeholders, business management, and other strategic… more
- S&P Global (CO)
- …security technologies, approaches, and best practices. + Experience with cloud security, network security, and secure coding practices. + Excellent communication ... they are more apt to bring new opportunities. Additionally, our work to reduce risk contributes to the value returned to our customers and shareholders. We engage… more
- The Cigna Group (Maitland, FL)
- …Market Provider Performance, Sales, Health Services, Clinical, Stars & Risk Adjustment, Finance, Marketing, Cross-Segment Contracting, Provider Relations, and ... Network Development & Solutions). Reporting to the Provider Performance...relationships in order to drive optimal performance on Stars, risk adjustment, utilization management, and overall financial performance. +… more
- Capital One (Plano, TX)
- …risks and needed updates. Lead continuous monitoring activities and updates to risk assessments, audit universe, and audit plan.** + **Direct business unit and ... project audits across assigned portfolios.** + **Review engagement planning documentation and audit programs to ensure adequate coverage of risk and sufficient… more
- Comerica (Frisco, TX)
- … mitigation plans are actively managed and adjusted as appropriate. * Effective engagement with regulators, audit and risk teams as required. Financial Planning ... systems, email security, security event monitoring systems, endpoint security, and network security engineering. This position will be responsible for ensuring the… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to a team of clinical (RN) reviewers and offers guidance on clinical and coding integrity reviews that are required by the FEP Association to ensure compliance and ... requirements which is required to identify opportunities to mitigate audit risk and/or implement innovative solutions for processing efficiencies. The role involves… more