Remote Director, Risk Adjustment Regulatory Audits
Humana Inc
- Remote job
Humana Inc. is seeking a Director of Risk Adjustment Regulatory Audits to lead strategy and execution of external audits, ensuring strong operational processes and timely submissions. The role reports to the Associate VP, Risk Adjustment Compliance and works in a remote capacity with occasional travel to Humana offices. You will drive analytics of audit data, collaborate across Quality Cost & Strategy, and leverage technology to improve efficiency. #J-18808-Ljbffr Humana Inc
$157.3k - $262.7k
## Director, Risk AdjustmentApply: California-Remote: Full time: Posted 2 Days Ago: JR100164Come Grow... ...and execute a risk adjustment strategy aligned to organization goals, regulatory requirements, and performance... ...medical record review and audit process to ensure adherence...Remote workRegulatoryFull time$196.73k - $286.9k
...we're Oscar. We're hiring a Senior Director, Actuarial - Risk Adjustment to join our Actuarial team. Oscar... ...Location: This position is fully remote and open to candidates residing in... ...including monthly close, external audits, regulatory reviews, and other finance-related...Remote workRegulatoryFull timeWork from homeHome office$150k - $206.3k
Become a part of our caring community The Director, Risk Management identifies and analyzes potential sources... ...across the function or segment. This is a remote position. The Director of Risk Adjustment Regulatory Audits will be responsible for developing strategy and...Remote workRegulatoryFull timeTemporary workApprenticeshipWork at officeWork from homeHome office$87.7k - $157.8k
...for facilitation and leading external audits related to Risk Adjustment processes. Ensures visibility by way... ...job have the flexibility to work remote from home anywhere in the Continental... ...to inquiries from state and federal regulatory agencies timely. Quality Review all...Remote workRegulatoryFull timePart timeWork at officeWork from homeFlexible hours$118.6k - $157.14k
...experience!Reporting to the Director of Risk Adjustment Prospective Programs, the... ...data to state and federal regulatory bodies (CMS and/or State Medicaid... ..., and maintaining audit readiness. Commitment to Quality... ...schedule. (Monday & Friday - remote, Tuesday - Thursday onsite...Remote workRegulatoryTemporary workWork experience placementLocal areaMonday to Friday- ...Description: Summary The Supervisor, Risk Adjustment Quality Assurance and Auditing, is responsible for oversight of... ...audits in alignment with regulatory requirements and organizational policies... ...note: There may be opportunity for remote work within all jobs posted by the...Remote workRegulatoryContract workWork from homeHome office
- ...hiring a Program Manager Risk Adjustment Coding and this... ...operations meet evolving regulatory market provider and member... ...closely with the Director this position supports... ...role leads coding and audits review activities including... ...is working full time remote. Hybrid is a...Remote workRegulatoryFull timeFor contractorsWork at office2 days per week
$83.99k - $119.97k
...POSITION: The Program Manager, Risk Adjustment & Stars, serves as the... ...policies. ~ Supports RADV audit readiness and health plan... ...to translate technical and regulatory detail for operational and executive... ...is HIPAA compliant for all remote or telecommuting positions...Remote workRegulatoryFull timeHome office- ...Director, Risk Management SIG SAUER, Inc. is a leading... ...airguns, suppressors, remote controlled weapons stations... ...compliance with regulatory requirements. The Director... .... Conduct regular audits to ensure risk... ...insurance claims. Work with adjusters and legal teams to resolve...Remote workRegulatoryWork at office
$149.5k
...often (in days) to receive an alert: Director, Risk Adjustment Strategies and Initiatives Job... ...organization has accurate information for regulatory submissions and ensures compliance... ..., suspecting, reconciliation, and audit preparation. Proven ability to lead...RegulatoryFull timeWork at office$160k - $195k
Sr. Director - Risk Adjustment Department: Quality - Risk Adjustment Employment... ...risk adjustment accuracy, regulatory compliance, provider performance... ...internal monitoring, audits, and regulatory review activities... ...Conditions This is a remote position. Travel is required...Remote workRegulatoryFull timeContract work$197k - $270k
## Director of RiskApply: Washington D.C.: Chicago... ...The Director of Risk is a senior role... ...or would consider remote. Reports to:... ...complete and defensible audit trail of client... ...operations and associated regulatory obligations.Pay... ...and/or adjustments during our recruitment...Remote workRegulatoryFull timeContract workFor contractorsWork experience placementFor subcontractorWork at officeLocal area$134.6k - $230.8k
Optum NY, is seeking an Executive Director of Risk Adjustment join our team in New York, NY. Optum is a clinician-led care organization... ...capture into clinical workflows while maintaining regulatory compliance and audit readiness. Primary Responsibilities: Risk Adjustment...RegulatoryMinimum wageFull timeWork experience placementLocal areaWork from home$127.34k - $216.47k
...person’s talents and strengths. The Director of Risk Adjustment, reporting to the Vice President of... ...forecasting, and scenario modeling; evaluate regulatory and payment methodology impacts; and... ...lineage, operational insights, and audit readiness. Ensure audit readiness...RegulatoryFull timeWork experience placementWork at office- Medical Director - Medicare Risk Adjustment HCC Review - Puerto Rico (Option to be Florida Based) Option to... ...process requests for medical record audits, including inpatient hospitalizations... ...with policies, procedures, bylaws, regulatory requirements, and best-practice guidelines...RegulatoryFull timeLive inWork at officeMonday to Friday
$127k - $160k
...Summary The Senior Manager, Risk Adjustment Operations and Performance Improvement... ..., HEDIS, RADV, and internal audit activities. Provider... ...with CMS, NCQA, and regulatory requirements, with compliance... ...an office environment and/or remotely. The role involves frequent...Remote workRegulatoryFull timeWork at office$196.66k - $290k
...OVERVIEW The Director of Enterprise Risk Management (ERM)... ...Heads, Compliance, and Audit to develop, implement... ...strategic objectives, regulatory obligations, and stakeholder... .... For hybrid and remote positions, work may... ..., and the ability to adjust focus. This position...Remote workRegulatoryFull timeContract workWork at officeLocal areaMonday to Friday- Centene Corporation is seeking a Risk Adjustment Audit Manager to oversee external audits and lead delivery of audit deliverables. The role focuses on ensuring accuracy, regulatory alignment, and timely communication with auditors across the risk adjustment function. You...Remote jobRegulatory
- ...mind. We are looking for a Manager of Risk Managment to oversee Mass Advantages's full suite of Risk Adjustment activities. This position is responsible for... ...external vendors, interaction with Providers, regulatory audits, and compliance with CMS regulations. The...RegulatoryWork at office
$157.98k - $252.77k
...Blue Cross NC is hiring a Director, Enterprise Risk Management to lead the design... ...bodies, including the Audit Committee and Enterprise Risk... ...governing practices. Monitor regulatory, industry, and healthcare trends... ...you flexibility to work remotely with intentional in-person...Remote workRegulatoryWork at officeLocal areaFlexible hours2 days per week$66.8k - $116.8k
...experienced Recordkeeping Risk Manager to join our Workplace... ...and conduct onsite and remote recordkeeping audits to verify OSHA compliance,... ...to ensure compliance with regulatory agencies, federal and state... ...accommodation or adjustment during the application and...Remote workRegulatoryWork at officeWorldwideFlexible hours$157.98k - $252.77k
...Director, Enterprise Risk Management Blue Cross NC is hiring a Director, Enterprise... ...bodies, including the Audit Committee and Enterprise... ...governing practices. Monitor regulatory, industry, and healthcare... ...you flexibility to work remotely with intentional in-person...Remote workRegulatoryWork at officeLocal areaFlexible hours2 days per week- ...Job Description The Director of Governance and Risk will report to the CISO within... ...is 4 days in office, 1 day remote per week, based at our corporate... ...of risks to the Board, Audit committee, and ERM Lead... ...activities Ensure regulatory compliance with frameworks...Remote workRegulatoryContract workTemporary workWork at officeLocal area1 day per week
$165k - $240k
...on-site, (2) hybrid, or (3) fully remote. Hybrid roles are generally expected... ...business need.The OpportunityThe Senior Director – Fraud & Payments Risk is a newly created, independent... ...performance, emerging risks, and audit or regulatory issue closure.Independent Oversight...Remote workRegulatoryFull timeTemporary workPart timeWork experience placementWork at officeRelocation packageFlexible hours- ...and guidelines. You will provide audit findings, educate coders, and maintain up-to-date knowledge of regulatory requirements. The role supports Medicaid, Medicare Advantage Risk Adjustment, or Commercial lines and is suited to a remote work environment with strong organizational...Remote jobRegulatory
- ...Health is seeking a skilled HCC coder to deliver risk adjustment coding for MA, ACA, and ESRD projects. You will... ...requirements. The role emphasizes accuracy, regulatory audits support, and process improvements, with remote, office-based work and up to 25% travel. #J-18...Remote jobRegulatoryWork at office
- ...Risk Adjustment Coding Auditor The Risk Adjustment Coding Auditor ensures the accuracy and... ...documentation gaps, mitigating financial and regulatory risk, and improving data integrity. It... .... Protects patient records and audit information by ensuring compliance with...Remote workRegulatory
$120k - $145k
...Manager, Risk and Insurance Job Type:... ...(office onsite) | Remote United States Reports To: Director, Finance Department... ...insurance brokers, adjusters, and other third... ...records. Conduct audit of existing insurance... ..., processes, and regulatory requirements. Review...Remote workRegulatoryFull timeLocal area$192.9k - $258k
...supported. Your role at a glance The Director, Construction Risk and Audit is responsible for developing,... ...delivery, costs, schedules, regulatory compliance, supply chains, labor markets... .... This role is expected to work remote with ability to travel up to 25% to...Remote workRegulatoryFull timeContract workTemporary workWork at officeLocal areaFlexible hours$126k - $191.63k
Leads the Enterprise Risk Management and Business Resilience teams... ...Partner with Internal Audit on testing schedules and shared... ...up under questioning Track regulatory developments and emerging exposure... ...interdependencies For roles that are remote (i.e., Work From Home (WFM))...Remote workRegulatoryFull timeWork from homeShift work
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