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You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit.<ul><li>Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities.</li></ul><ul><li>Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making.</li></ul><ul><li>Supports effective implementation of performance improvement initiatives for capitated providers.</li></ul><ul><li>Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.</li></ul><ul><li>Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.</li></ul><ul><li>Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership.</li></ul><ul><li>Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes.</li></ul><ul><li>Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.</li></ul><ul><li>Participates in provider network development and new market expansion as appropriate.</li></ul><ul><li>Assists in the development and implementation of physician education with respect to clinical issues and policies.</li></ul><ul><li>Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.</li></ul><ul><li>Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.</li></ul><ul><li>Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality.</li></ul><ul><li>Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.</li></ul><ul><li>Develops alliances with the provider community through the development and implementation of the medical management programs.</li></ul><ul><li>As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues.</li></ul><ul><li>Represents the business unit at appropriate state committees and other ad hoc committees.</li></ul><ul><li>May be required to work weekends and holidays in support of business operations, as needed.</li></ul>Education/Experience: Medical Doctor or Doctor of Osteopathy. Utilization Management experience and knowledge of quality accreditation standards preferred. Actively practices medicine. Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous. Experience treating or managing care for a culturally diverse population preferred. License/Certifications: Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services. Current Arizona state license as a MD or DO without restrictions, limitations, or sanctions from government programs.For Arizona Complete Health: Canadian Board certification and/or American Board of Quality Assurance &amp; Utilization Review Physicians (ABQAURP) Board credentials. Current Arizona state license as a MD or DO without restrictions, limitations, or sanctions from government programs. Pay Range: $221,300.00 - $420,500.00 per yearCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Oklahoma Complete Health

Remote Medical Director - Arizona

Jenks Public Schools

ESY Special Education Teacher

<a href="#"> </a> <a href="#">About Us</a> <a href="#">Current Employee Job Search</a> <a href="#">Go to Hillcrest HealthCare System Careers</a> <ul> <li> <a href="#">Home</a> <a href="#">Home</a> </li> <li> <a href="#">Locations</a> <a href="#">Locations</a> </li> <li> <a href="#">Nursing Careers</a> <a href="#">Nursing Careers</a> </li> <li> <a href="#">Provider Careers</a> <a href="#">Provider Careers</a> </li> <li> <a href="#">Corporate Careers</a> <a href="#">Corporate Careers</a> </li> <li> <a href="#">Executive Careers</a> <a href="#">Executive Careers</a> </li> <li> <a href="#">Join Talent Community</a> <a href="#">Join Talent Community</a> </li> </ul> <ul> <li> <a href="#">Home</a> </li> <li> <a href="#">Locations</a> </li> <li> <a href="#">Nursing Careers</a> </li> <li> <a href="#">Provider Careers</a> </li> <li> <a href="#">Corporate Careers</a> </li> <li> <a href="#">Executive Careers</a> </li> <li> <a href="#">Join Talent Community</a> </li> <li> <ul> <li><a href="#">Careers Home</a></li> <li><a href="#">Search Jobs</a></li> </ul> </li> </ul> Candidates residing in the following states, CA, CO, CT, HI, IL, MA, MD, ME, MI, MN, NH, NV, NY, OR, RI, VT, WA, Washington DC and WV, must be willing to relocate if they are hired in a remote role. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. FOLLOW US <a href="https://www.linkedin.com/company/hillcrest-healthcare-system" target="_blank"> </a> <a href="https://www.youtube.com/user/HillcrestMedicalCtr" target="_blank"> </a> <a href="https://www.facebook.com/UticaPark" target="_blank"> </a> <h4>ARDENT HEALTH SERVICES</h4> Ardent Health Services invests in quality health care. In people, technology, facilities and communities, Ardent makes considerable investments – producing high quality care and extraordinary results. <h4>CONTACT US</h4> 340 Seven Springs Way Suite 100, Brentwood, TN 37027 (615) 296-3000 We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Copyright © Ardent Health Services. All rights reserved. <a href="#">Providerrecruitment@ardenthealth.com</a> <a href="#">Providerrecruitment@ardenthealth.com</a> <a href="#">Providerrecruitment@ardenthealth.com</a> <a href="#">Providerrecruitment@ardenthealth.com</a> <a href="#">Providerrecruitment@ardenthealth.com</a> <a href="#">Providerrecruitment@ardenthealth.com</a>

Utica Park Clinic

Outpatient Rheumatology NP Employment | Tulsa, OK | No Weekends/No Call

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Reviews, interprets and summarizes proposed and enacted legislation and regulatory updates to the business as a subject matter expert on various complex topics. Performs state or federal policy research and regulatory change monitoring with a goal of achieving formal regulatory approval of commercial/Marketplace products.<ul> <li>Identifies, analyzes and interprets proposed or enacted legislation related to Centene's commercial product at the federal and state level and communicates findings to impacted departments. Independently performs risk assessments, including impact to business applications and downstream output. Maintains database and other reference materials related to legislative and regulatory issues and compliance.</li> <li>Performs comprehensive, complex regulatory analyzes, including the review, summarization and dissemination of key regulatory updates and changes related to Commercial/ACA rules and regulations at the state and/or federal level. Leads regulatory interpretation related to Commercial/ACA Rules and regulations and the commercial product explaining concepts clearly and adapting language and presentation based on audience level. Provides advice to business as new regulations emerge.</li> <li>Uses persuasive arguments and secures cooperation from the business in order to address potential legal, contractual and/or regulatory issues. Ability to determine appropriate approach for solving regulatory problems.</li> <li>Develops trust-based relationships within varied audiences and collaborates with other functional areas to lead large projects and initiatives. Attends cross-departmental meetings as department representative, provides guidance to the business related to commercial regulatory requirements and appropriately escalates matters to management. Solutions to address potential legal, contractual and/or regulatory issues which arise working closely with Legal and Compliance.</li> <li>Support and manage relationships between health plans and regulatory agencies, including state and federal regulators. Independently drafts responses to external requests for information required by the organization for its regulatory filings and/or for policy needs.</li> <li>Responsibility for understanding regulations and business needs for multiple states, as well as federal regulations pertaining to the commercial health insurance market.</li> <li>Assesses and analyzes objections related to regulatory interpretation and leads drafting of appropriate responses which are provided to regulators related to commercial/ACA filings. Partners on response with cross-functional partners as needed.</li> <li>Leads the research and regulatory guardrails for new state entry and new product development, working closely with legal on preparation of COA application materials/submissions for new states and/or products.</li> <li>Assists in developing and mentorship of junior employees, supporting creation and revisions to training materials. May attend external and/or virtual conferences and seminars to evaluate industry trends.</li> <li>May attend external and/or virtual conferences and seminars to evaluate industry trends.</li> <li>Performs other duties as assigned</li> <li>Complies with all policies and standards</li> </ul>Education/Experience: Bachelor's Degree in Business, Communications, Healthcare, Political Science/Pre-Law or equivalent experience required: Master's Degree in a related field, Juris Doctorate degree may be considered in place of experience preferred. 4+ years experience in health insurance, legal, compliance or related field required. Experience reviewing regulations and providing interpretation using terms appropriate for the audience preferred. Experience in commercial health insurance and/or behavioral health managed care preferred. Please note: this is a remote position with Central Time (CT) work hours.Pay Range: $68,700.00 - $123,700.00 per yearCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Regulatory Operations Analyst III

<ul> <li> <a href="https://koch.avature.net/en_US/careers/SearchJobs" target="_blank"> &lt; Back to Search Results </a> </li> </ul> <h2> Field Service Technician </h2> Location(s) Lexington, Kentucky | Louisville, Kentucky | Not Provided, Kentucky | Tulsa, Oklahoma Eligible for remote Yes Company John Zink Hamworthy Combustion Career Field Maintenance &amp; Skilled Trades Job Number 163401 <a href="https://koch.avature.net/en_US/careers/Login?jobId=163401" target="_blank"> Apply now </a> <a href="#"> Share </a> <ul> <li> <a href="#">Email</a> </li> <li> <a href="https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fkoch.avature.net%2Fen_US%2Fcareers%2FJobDetail%2FKentucky-United-States-Field-Service-Technician-Vapor%2F163401&amp;display=popup" target="_blank">Facebook</a> </li> <li> <a href="http://twitter.com/intent/tweet?url=https%3A%2F%2Fkoch.avature.net%2Fen_US%2Fcareers%2FJobDetail%2FKentucky-United-States-Field-Service-Technician-Vapor%2F163401&amp;text=Field+Service+Technician+-+Vapor" target="_blank">X</a> </li> <li> <a href="https://koch.avature.net/_linkedinApiv2?portalUrl=https%3A%2F%2Fkoch.avature.net%2F&amp;action=INIT_SHARE&amp;shareUrl=https%3A%2F%2Fkoch.avature.net%2Fen_US%2Fcareers%2FJobDetail%2FKentucky-United-States-Field-Service-Technician-Vapor%2F163401" target="_blank">LinkedIn</a> </li> </ul> Your Job John Zink is hiring for a Field Service Technician in the vapor group supporting the refining and petrochemical industries! John Zink Company, a Koch Engineered Solutions (KES) company, serves customers with innovative, engineered-to-order solutions. Our equipment group business supplies components for applications in various markets with a focus on the refining and petrochemical Industry. Our Field Service Technicians support our customers at their sites across the country with their commissioning, maintenance and other service needs. Our Team John Zink Company, a Koch Engineered Solutions (KES) company, serves customers with innovative, engineered-to-order solutions. Our equipment group business supplies components for applications in various markets with a focus on the refining and petrochemical Industry. Our Field Service Technicians support our customers at their sites across the country with their commissioning, maintenance and other service needs. Benefits: <ul> <li>John Zink is the leader in the Vapor space with the largest install base in North America.</li> <li>The typical base pay range for this position at the start of employment is expected to be between $40-$45 per hour but could be higher if you are experienced in the industry. We also have excellent health and retirement benefits.</li> <li>Company Truck, Credit Card, Cell Phone and Laptop</li> </ul> What You Will Do <ul> <li>Travel to jobs sites from your home office to perform checkout, testing, troubleshooting and commissioning/ startup of a wide variety of electrical and mechanical equipment for our manufactured equipment. This equipment includes, but is not limited to the following: pumps, motors, VFD’s, positioners, valves, actuators, and transmitters, combustion equipment, emission monitoring equipment, recorders, and programmable logic controllers (PLC).,</li> <li>Specialists will be required to commission, troubleshoot and alter different types of PLC’s (programmable controllers, mainly Allen Bradley and Siemens) PID loop controllers, VFD’s, HMI’s, and other control devices.</li> <li>Be on call for customer service as needed.</li> <li> Modify technical documents and drawings (redlines) to represent final field changes and corrections for commissioning of equipment.</li> <li>Travel extensively within your region and potentially the US, up to 75% travel is expected.</li> </ul> Who You Are (Basic Qualifications) <ul> <li>Experience programming, calibrating, and configuring 4-20 MA loop devices.</li> <li>Experience for modifying, diagnosing and troubleshooting PLC’s (programmable Logic Controllers) such as, but not limited to, Allen Bradley and GE brands.</li> <li>Experience understanding and applying National Electrical code (NEC)</li> <li>Experience reading and understanding P&amp;ID’s, fabrication drawings, and electrical schematics.</li> <li>Able to travel over 75% of the time.</li> <li>A TWIC (Transportation Workers Identification Card) will have to be obtained within first six (6) weeks of employment.</li> <li>Valid Driver’s License, Able to drive a Company vehicle and respond to customers as the need arises.</li> </ul> Physical requirements: <ul> <li>Able to lift up to 50# on occasion and 25# routinely, able to bend, stoop, crawl and maneuver around skidded equipment and piping.</li> <li>Able to hear distinct sounds, visualize all colors of spectrum and visually see up close and at distance.</li> <li>This work is in an outdoor environment and long workdays on occasion.</li> </ul> What Will Put You Ahead <ul> <li>Experience with Allen Bradley Control Logix, RS Linx, GE Rx3i, and other comparable Manufacturer’s Programmable Logic Controllers (PLC)</li> <li>2-year Technical Degree from an accredited college or trade school in a mechanically-based technical major, OR 4 years of military service working with boilers</li> <li>Field work experience in the petrochemical, power generation, renewable energy, pulp &amp; paper or food processing industries.</li> <li>Experience with Modicon and Siemens Programmable Logic Controllers (PLC)</li> <li>Electrical journeyman license</li> <li>Experience with Industrial safety, OSHA and NFPA 70E. </li> <li>Experience working on all types of industrial, electrical and electronic equipment including, but not limited to motors, VFD’s, positioners, valves, actuators, transmitters and PLC equipment.</li> </ul> For this role, we anticipate paying $25 - $47 per hour. This role is eligible for variable pay, issued as a monetary bonus or in another form. At Koch companies, we are entrepreneurs. This means we openly challenge the status quo, find new ways to create value and get rewarded for our individual contributions. Any compensation range provided for a role is an estimate determined by available market data. The actual amount may be higher or lower than the range provided considering each candidate's knowledge, skills, abilities, and geographic location. If you have questions, please speak to your recruiter about the flexibility and detail of our compensation philosophy. Hiring Philosophy All Koch companies value diversity of thought, perspectives, aptitudes, experiences, and backgrounds. We are Military Ready and Second Chance employers. Learn more about our hiring philosophy <a href="https://jobs.kochcareers.com/pages/culture" target="_blank">here</a>. Who We Are As a Koch Engineered Solutions company, John Zink (JZ) is a global leader in emissions control and a pioneer in modern Smart Combustion solutions. Our research and development facilities make up the largest testing complex of its kind. Additionally, our worldwide service organization is the largest, most technically advanced team of its kind. We provide solutions to capture emissions, destroy pollutants, manage waste and heat vital processes to help industries operate more cleanly and efficiently. At Koch, employees are empowered to do what they do best to make life better. Learn how our <a href="https://www.kochind.com/about/business-philosophy" target="_blank">business philosophy</a> helps employees unleash their potential while creating value for themselves and the company. Our Benefits Our goal is for each employee, and their families, to live fulfilling and healthy lives. We provide essential resources and support to build and maintain physical, financial, and emotional strength - focusing on overall wellbeing so you can focus on what matters most. Our benefits plan includes - medical, dental, vision, flexible spending and health savings accounts, life insurance, ADD, disability, retirement, paid vacation/time off, educational assistance, and may also include infertility assistance, paid parental leave and adoption assistance. Specific eligibility criteria is set by the applicable Summary Plan Description, policy or guideline and benefits may vary by geographic region. If you have questions on what benefits apply to you, please speak to your recruiter. Additionally, everyone has individual work and personal needs. We seek to enable the best work environment that helps you and the business work together to produce superior results. Equal Opportunities Equal Opportunity Employer, including disability and protected veteran status. Except where prohibited by state law, some offers of employment are conditioned upon successfully passing a drug test. This employer uses E-Verify. Please click <a href="https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf" target="_blank">here</a> for additional information. #LI-DM1 <a href="https://koch.avature.net/en_US/careers/Login?jobId=163401" target="_blank"> Apply now </a> <a href="#"> Share </a> <ul> <li> <a href="#">Email</a> </li> <li> <a href="https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fkoch.avature.net%2Fen_US%2Fcareers%2FJobDetail%2FKentucky-United-States-Field-Service-Technician-Vapor%2F163401&amp;display=popup" target="_blank">Facebook</a> </li> <li> <a href="http://twitter.com/intent/tweet?url=https%3A%2F%2Fkoch.avature.net%2Fen_US%2Fcareers%2FJobDetail%2FKentucky-United-States-Field-Service-Technician-Vapor%2F163401&amp;text=Field+Service+Technician+-+Vapor" target="_blank">X</a> </li> <li> <a 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John Zink Hamworthy Combustion

Field Service Technician

<ul> <li> </li> </ul> We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. FOLLOW US <h4>ARDENT HEALTH SERVICES</h4> Ardent Health Services invests in quality health care. In people, technology, facilities and communities, Ardent makes considerable investments – producing high quality care and extraordinary results. <h4>CONTACT US</h4> One Burton Hills Blvd. Suite 250 Nashville, TN 37215 (615) 296-3000 We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Copyright © Ardent Health Services. All rights reserved. Here is the google script and the instructions: Paste this code as high in the of the page as possible: Additionally, paste this code immediately after the opening tag:

Employed Endocrinology Opening | Oklahoma Heart Institute | Tulsa, OK

Clock and Scorebook Keeper

Overview Responsible for being the clinical expert in the delivery of quality, effective patient care through the management and oversight of company clinical resources, processes, and outcomes. This role is also responsible for the assurance of compliance with local, state, federal and accreditation standards for all care centers within an assigned geographical area. Responsibilities <ol> <li>Supervises all aspects of the hospice clinical program within assigned POD.</li> <li>Serves as the territory clinical leader, both internally and externally facing, and collaborates extensively with POD leadership team (Area Vice President Operations and Area Vice President of Business Development) to ensure operational excellence.</li> <li>Reviews care center quality measures monthly with care center and POD leadership to develop and analyze indicators identifying trends in the delivery of care and clinical operation efficiencies. Provides guidance and direction for care center management and staff on matters affecting the delivery of services to patients. Creates, implements, and monitors performance improvement activities at the care center and POD level to drive clinical operations and quality metrics to and above the baseline of state/ federal/company scores.</li> <li>Ensures that corporate and regional clinical initiatives are implemented, outcomes monitored, and education provided to care center leadership, clinicians, and business development partners, as applicable, including the supervision of specialty programs.</li> <li>Performs comprehensive assessments and analysis of clinical process management in the care center and in delivery of patient care. Provides education on company policy, clinical processes, and procedures as well as follow-up to validate timely resolution of action items.</li> <li>Directs and oversees clinical process improvement methods, provides direction for care center staff, assists care center leadership in the development of corrective action plans and provides education for care center leadership in the implementation of processes.</li> <li>Provides support, direction, and feedback to staff during the clinical and compliance processes.</li> <li>Communicates with corporate Compliance regarding any reportable findings or issues identified in a care center that would potentially put a patient or the company at risk.</li> <li>Facilitates education based on care center and region assessment findings.</li> <li>Partners with Area Vice President of Operations to adjustment clinical operations, expenses, and staffing to address needs in quality improvement and fiscal metrics. Reviews with care center leadership and drives improvement of clinical aspects of documentation requirements and the reimbursement process.</li> <li>Serves as an expert resource to the care center and region leadership regarding Medicare conditions of participation, company policy, and Medicare management including providing support, direction, oversight for care centers to ensure proper and timely follow up during state/ accreditation surveys, internal surveys, ADR/TPE requests, as well as implementation of clinical and compliance processes.</li> <li>Supervises care center clinical competency including on-boarding expectations including, but not limited to, clinical orientation of Director of Operators and Clinical Managers. Provides assistance/oversight for care center clinician orientation, as needed. Works with the corporate and regional leadership in identifying opportunities for additional or needed training and provides it.</li> <li>Participates in the interview process for all clinical and care center leadership positions, as needed. Monitors and evaluates care center leadership performance. Holds leadership accountable for the attainment of defined goals and objectives. Executes effective performance redirection when needed.</li> </ol> <ol> <li>Develops leaders through coaching, mentoring, and formal/on the job training and development opportunities.</li> <li>Directs and oversees quarterly quality assurance / performance improvement (QAPI) activities with communication to care center and region leadership and acts as a resource regarding policy interpretation, process improvement and follow-up actions required.</li> <li>Provides oversight and tracking of LLOS Bill to ensure proper and timely follow-up.</li> <li>Performs other duties as assigned.</li> </ol> Knowledge, Skills and Abilities: <ul> <li>Experience with state/CMS Survey Process.</li> <li>Experience with use of Homecare Homebase and Electronic Medical Record.</li> </ul> Qualifications Required <ul> <li> Current, unencumbered license to practice as Registered Nurse. An employee in this role is only able to provide clinical guidance to patients in states in which the employee possesses a current, unencumbered license. May possess either a single state license in each non-compact state and/or a compact license in their state of residence that is accepted in all Nurse License Compact (NLC) participating states.<ul><li>Nurse Licensure Compact (NLC) documents the following: The mutual recognition model of nurse licensure allows a nurse to have one license (in his or her state of residency) and to practice in other states (both physical and electronic), subject to each state's practice law and regulation. Nurses must legally reside in a NLC state to be eligible to have a multi-state license. See list of Nurse Licensure Compact (NLC)</li></ul> </li> <li>Five (5+) years clinical experience; at least three (3+) years in a management/supervisory capacity in Home Health or Hospice industry.</li> </ul> Amedisys is an equal opportunity employer. All qualified employees and applicants will receive consideration for employment without regard to race, color, religion, sex, age, pregnancy, marital status, national origin, citizenship status, disability, military status, sexual orientation, genetic predisposition or carrier status or any other legally protected characteristic.

Amedisys

SS HSP AVP Clinical

Speech and Language Pathology Assistant

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: The Director, Risk Adjustment is a key strategic leader responsible for driving the Risk Adjustment for various lines of business and achieving related revenue targets. This includes identifying opportunities to improve completeness as well as accuracy of risk adjustment data submitted to CMS and HHS. This leader is also responsible for the development, analysis and reporting of key risk adjustment metrics, as well as overseeing analyses of new legislation and regulations regarding Risk Adjustment and assessing the impact of any changes in the programs.<ul> <li>Partner with executive leadership to plan the strategic direction of Risk Adjustment initiatives to facilitate achievement of the business goals and objectives and success criteria for the future. Evaluate and oversee the development and implementation of CMS and HHS risk adjustment program changes. Incorporate changes and requirements into strategy.</li> <li>Coordinate with appropriate functional areas including Medical Management, Quality, Pharmacy, Operations, etc. as it relates to Risk Adjustment, Clinical Risk Groups and Quality initiatives. Use analytics to define Risk Adjustment focus. Identify areas to increase quality and maximize opportunities.</li> <li>Direct the development of key analytics and data to support Risk Adjustment financial forecasts, analysis and reporting to engage key stakeholders and communicate program results to the organization. Educate internal and external stakeholders on changes in regions and the critical nature of risk adjustment and recommend areas of process improvement.</li> <li>Maximize return on investment in Risk Adjustment operations by reducing reliance on vendors and increasing validity of data submissions.</li> <li>Maintain and oversee an effective and optimal Risk Adjustment submission process and Quality Assurance Program. Monitor, measure and communicate Risk Adjustment performance and submission quality relative to the various program strategies.</li> <li>Develop performance targets for both internal and external constituents. Ensure that performance targets are set and included in contracts where appropriate. Track progress against stated goals and drive to attainment.</li> <li>Verify that data submissions are complete and accurate and that the pertinent authority has confirmed receipt. Serve as the subject matter expert in projects and initiatives. Drive Risk Adjustment best-practices across all lines of business.</li> <li>Ensure alignment and attainment of Risk Adjustment goals with business owners. Develop and implement employee training and provider outreach programs, as needed, to improve Risk Adjustment performance.</li> </ul>Education/Experience:<ul> <li>Bachelor's degree in applicable field or equivalent experience required</li> <li>Position requires at least two years of experience with Risk Adjustment.</li> <li>Experience at a Manager or Director level is preferred.</li> <li>Experience with actuarial, finance and/or operational activities of a health plan.</li> <li>Demonstrated success in improving Risk Adjustment measures.</li> <li>Demonstrated success leading cross-functional teams.</li> <li>Ability to prioritize tasks with competing deadlines.</li> </ul>Pay Range: $110,900.00 - $205,000.00 per yearCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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