- AmeriHealth Caritas Health Plan (Newtown Square, PA)
- …as the leader responsible for driving the Quality Performance Reporting & Analytics and Risk Adjustment for Medicaid Quality, Medicare Stars, and Exchange ... and drive transparency and collaboration across all levels. It combines expertise in risk adjustment and quality performance, with oversight of strategies that… more
- DW Simpson (Portola Valley, CA)
- …least 2 years of supervisory experience. Must have a deep understanding of CMS risk adjustment , Medicaid rate-setting, and Medicare Advantage/Part D payment ... revenue, claims modeling, & financial analysis and will assess & refine risk -adjusted revenue projections for Medicare -Medicaid populations. The ideal candidate… more
- Elevance Health (Mendota Heights, MN)
- ** Medicare Risk Adjustment Actuarial Analyst III** **On-Site Requirement: Hybrid 1;** **This role requires associates to be in-office 1 - 2 days per ... for employment, unless an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Actuarial Analyst III** is responsible for… more
- Marshfield Clinic (Marshfield, WI)
- …to support the most exciting missions in the world!** **Job Title:** Director of Actuarial and Risk Adjustment Services **Cost Center:** 682891378 SHP- ... of America) **Job Description:** **JOB SUMMARY** The Director of Actuarial & Risk Adjustment Services...excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment.… more
- CVS Health (Boston, MA)
- …regulatory compliance. + Serve as a subject matter expert on CMS regulations, risk adjustment , and revenue optimization. + Collaborate with internal stakeholders ... CMS Part C/D operations. + 5+ years' experience working with CMS regulations, risk adjustment methodologies, and revenue management. + 5+ years' experience… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- Ready to help us transform healthcare? Bring your true colors to blue. The Medicare Risk Adjustment Strategy Program Manager will report to the Senior ... Director of Medicare Risk Adjustment and Analytics....Medicare Product, Provider Contracting, Health and Medical Management, Actuarial , and Finance + Actively manage the facilitation of… more
- Highmark Health (Pittsburgh, PA)
- …At least five years' direct management experience Preferred: + 5 or more years' Medicare and/or Commercial risk adjustment experience + Previous involvement ... Management: + Provide strategic leadership and management for the Risk Adjustment Accuracy Management Department. + Develop...to identify both opportunities and weaknesses in the government's actuarial risk score models to inform better… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …Bring your true colors to blue. Under the direction of the Senior Director of Medicare Risk Adjustment and Analytics, the Associate Director of Risk ... externally. The role is responsible for the strategy, execution and performance of Medicare risk adjustment reporting and analytics, infrastructure and… more
- Molina Healthcare (Roswell, NM)
- …Analytics role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis ... complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data to evaluate healthcare...risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA… more
- CareFirst (Baltimore, MD)
- …Risk Adjustment oversees the outcomes and operations of risk adjustment across the organization within Medicare Advantage, Medicaid & ACA markets. The ... reports. Serve as an SME to guide CareFirst's VP of Enterprise Quality & Risk Adjustment , Finance, Actuarial , and P/L owners of Lines of business in bid… more
- Datavant (Little Rock, AR)
- …and managing in a remote environment (2+ years) + 3+ years of experience working with Medicare , ACA, and/or Medicaid risk adjustment models + 5+ years of ... 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
- Centene Corporation (Queens, NY)
- …+ Develop and refine Medicare contract models to incorporate RAF ( Risk Adjustment Factor) trends, Stars quality metrics, and benchmarking methodologies to ... execution of the organization's Value-Based Payment strategies (VBP) and other risk -based contracting strategies. + Oversee Medicare -specific VBP contracts,… more
- Centene Corporation (Providence, RI)
- … Medicare contract models, incorporating CMS and NYSDOH guidelines related to risk adjustment , quality metrics, and financial benchmarks. + Collaborate with ... management and Service Fund teams to implement monitoring of Medicare -specific VBP contracts, including models with upside/downside risk...internal teams (eg, Actuarial , Clinical, Legal, and Provider Relations) to align on… more
- WelbeHealth (Los Angeles, CA)
- …Python, R), Excel, and financial modeling tools + Deep understanding of CMS risk adjustment , Medicaid rate-setting, and Medicare Advantage/Part D payment ... and financial analysis. This role will focus on overseeing capitation rates, risk adjustment methodologies, claims forecasting, and Incurred But Not Reported… 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 ... 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)
- …forecasting activities, actuarial analyses, accounting operations, financial reporting, risk adjustment and procurement functions. + Supports emerging ... multiple finance functions, including accounting, financial reporting, financial planning, forecasting, actuarial analysis and risk adjustment + Expert… more
- Deloitte (Tempe, AZ)
- …Experience with Medicaid waivers (ie, 1115, 1915 b/c, 1332) + Experience with risk adjustment mechanisms + Experience with Provider reimbursement streams (ie, ... Participate in the transformation of the health care sector through innovative actuarial solutions + Contribute to the development of evidence-based medicine and… more
- Point32Health (Canton, MA)
- …in a matrix environment collaborating with functions including risk adjustment , population health, finance, operations, actuarial , and sales. **Job ... and products. The Director will lead a team who negotiates contracts including risk arrangements to enable high performing provider networks that support goals for… more
- Evolent (Harrisburg, PA)
- …of Medicare claims, episode and condition groupers, case/episode and risk adjustment , patient attribution methodologies, and network analysis and pod ... + Bachelor's degree, preferably with a quantitative major (eg actuarial , statistics, biostatistics, operations research, mathematics, economics) or healthcare major… more
