- Milliman (Seattle, WA)
- …Familiarity with key industry metrics and frameworks, such as HEDIS, population health, risk adjustment , and value-based payment models. Prior experience in a ... providing actuarial consulting, retirement funding and healthcare financing, enterprise risk management and regulatory compliance, data analytics and business… more
- Banner Health (Phoenix, AZ)
- …This role leads enterprise strategies to improve cost efficiency, quality outcomes, risk adjustment accuracy, and contract performance across lines of business ... Professional (CPP); Chartered Property Casualty Underwriter (CPCU); Associate in Risk Management (ARM); CPA; SPHR; Registered Health Information Administrator… more
- Datavant (Lincoln, NE)
- …experiences to realize our bold vision for healthcare. **Role Overview** As a Product Manager , Risk Adjustment Analytics Products, you will contribute to the ... strategy and execution of analytics capabilities that power Datavant's risk adjustment solutions. You'll drive the development of robust, scalable, and… more
- Datavant (Little Rock, AR)
- …a remote environment (2+ years) + 3+ years of experience working with Medicare, ACA, and/or Medicaid risk adjustment models + 5+ years of data analytics and ... to realize our bold vision for healthcare. **What we're looking for:** The incoming Risk Adjustment Analytics Manager will be stepping into a role on the… more
- Elevance Health (Mendota Heights, MN)
- …are not limited to: + Analyzes and develops SAS and SQL programming to support Medicaid and Medicare Advantage risk adjustment initiatives. + Performs data ... **Medicare Risk Adjustment Actuarial Analyst III** **On-Site...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Marshfield Clinic (Marshfield, WI)
- …exciting missions in the world!** **Job Title:** Director of Actuarial and Risk Adjustment Services **Cost Center:** 682891378 SHP-Actuarial **Scheduled Weekly ... **Job Description:** **JOB SUMMARY** The Director of Actuarial & Risk Adjustment Services is a key leader...participation in any federally funded program, including Medicare and Medicaid . This is a condition of employment. Employee must… more
- Deloitte (Tempe, AZ)
- …with Medicaid waivers (ie, 1115, 1915 b/c, 1332) + Experience with risk adjustment mechanisms + Experience with Provider reimbursement streams (ie, DSH, UPL, ... health plan/insurance company experience + 5+ years of experience with Medicaid managed care capitation rate development and/or fee-for-service rate development +… more
- Molina Healthcare (Madison, WI)
- …Manager , Provider Engagement establishes strategies and operational directions for risk adjustment and quality improvement. Collaborates with senior ... strategies. Sets and manages performance goals, ensuring providers meet quality and risk adjustment targets through coaching and consistent engagement. Tracks… more
- New York State Civil Service (Bronx, NY)
- NY HELP Yes Agency Mental Health, Office of Title Intensive Case Manager (NY HELPS), New York City Children's Center, Bronx Campus, P26040 Occupational Category ... Duties Description NYCCC is recruiting a Director of Clinical Risk Management Department to oversee their Risk ...- Statewide (NY HELPS) program as an Intensive Case Manager if they have:* Bachelor's degree in social work,… more
- Datavant (Providence, RI)
- …inpatient setting. + Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment , CDI, Medicaid , Commercial RA, and HEDIS experience. + ... vision for healthcare. As a Sr. Client Coding Project Manager , you will plan, forecast, and manage client-facing coding...clients understand the shifts and trends happening in the risk adjustment coding space. **What you will… more
- Henry Ford Health System (Troy, MI)
- …value-based reimbursement models and initiatives. Reporting to the Director, Risk Adjustment and Value-Based Payment, the Program Manager is responsible for ... The Program Manager - Population Health & Value-Based Payment has an...departmental staff and multi-disciplinary teams. + Knowledge of Medicare, Medicaid , Blue Cross and other third-party payers billing and… more
- Tufts Medicine (Lowell, MA)
- …aligned with the Hospital Quality and Equity Incentive Program of the Massachusetts Medicaid 1115 Waiver. This work will spread across the Tufts Medicine Health ... Medical Officer for Quality, the Melrose Wakefield Hospital Senior Director Quality, Risk Management & Patient Safety and the Lowell General Hospital Vice President,… more
- Marshfield Clinic (Marshfield, WI)
- …internal and external stakeholders as it relates to Medicare Advantage, ACA/Exchange and Medicaid risk adjustment reimbursement methodologies and policies to ... ensure the accuracy and integrity of risk adjustment data submitted to the Centers... data submitted to the Centers for Medicare & Medicaid Services (CMS) and the Department of Health Services… more
- CareOregon (Portland, OR)
- …and forecasting activities, actuarial analyses, accounting operations, financial reporting, risk adjustment and procurement functions. + Supports emerging ... accounting, financial reporting, financial planning, forecasting, actuarial analysis and risk adjustment + Expert understanding of financial structures,… more
- Convey Health Solutions (Chicago, IL)
- …knowledge to accelerate analytic insights and new feature enhancements to Pareto's risk adjustment solution suite. Additionally, the ability to understand / ... which contribute to new features. + Collaborate with the Manager , Data Analytics and Product team to support analytical...questions for empowering key stakeholders to gain insights into risk adjustment performance. + Provide data analysis… more
- CareOregon (Portland, OR)
- …Medicare bid development, rate setting optimization, forecasting support, benchmarking, risk adjustment optimization, provider payment evaluation and review ... purposes of assessing our performance and the potential for improvement. | Monitor risk adjustment applied to capitation revenue and ensure population risk… more
- CareOregon (Portland, OR)
- …Medicare bid development, rate setting optimization, forecasting support, benchmarking, risk adjustment optimization, provider payment evaluation and review ... Exemption Status Exempt Management Level n/a Direct Reports n/a Manager Title Actuarial Services Manager Department Finance...our performance and the potential for improvement. + Monitor risk adjustment applied to capitation revenue and… more
- CareOregon (Portland, OR)
- …Experience in Medicaid , quality assurance, utilization review, case management, and/or risk adjustment + Experience with CareOregon or other CCO operations ... Level Director Direct Reports Sr Planning & Operations Specialist, Network Support Manager Manager Title Vice President, CareOregon Metro Department CareOregon… more
- Actalent (Sunrise, FL)
- …mental illness (SMI). Responsibilities + Lead a multidisciplinary team to identify high- risk clients, address care gaps, and collaborate with providers to enhance ... admissions and placements. + Conduct thorough needs assessments, including risk stratification, to determine health, psychological, educational, and social needs.… more
