- Providence (Portland, OR)
- …of WA, OR and CA. **The Role:** As the Director of Risk Adjustment and Strategic Accounts at Providence Health Plan, you will be the cornerstone of our ... strategic vision. You will oversee risk adjustment programs, spearhead provider education, and...ideas to life. + **Advocacy & Impact:** Represent Providence Health Plan in advocacy, shaping the future of healthcare… more
- Fallon Health (Worcester, MA)
- … adjustment program operations, the Senior Director of Risk Adjustment Solutions will provide Fallon Health with leadership and expertise to execute ... Twitter and LinkedIn. **Brief summary of purpose:** The Senior Director of Risk Adjustment is... is responsible for the execution and oversight of risk adjustment services for Fallon Health… more
- Ankura (New York, NY)
- …operations, investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment . The Senior Director will also ... of activities: + Help clients manage proactive and reactive Medicare and Commercial Risk Adjustment compliance, audit, and investigation projects for clients. +… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …any legally protected characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Director of Risk Adjustment Location: Hybrid | Eagan, Minnesota ... Special Services/Product Lines The Impact You Will Have The Director of Risk Adjustment is...Collaborate with Clinical and Care Management teams to align risk adjustment initiatives with population health… more
- Datavant (Augusta, ME)
- …for healthcare. **Role Overview** As the Director of Prospective + Concurrent Risk Adjustment Products, you will lead the strategy, roadmap, and execution ... on identifying and acting on undiagnosed conditions (prospective suspecting) and ensuring risk adjustment coding accuracy in near real-time (concurrent review).… more
- Highmark Health (Pittsburgh, PA)
- …and Coding for the Highmark Health Enterprise. Ensures that Highmark's Risk Adjustment programs comply with all applicable guidelines, regulations and laws ... for Medicare and Medicaid Services (CMS), the Department of Health and Human Services (HHS), and others established at...a team of internal coder / clinicians that perform Risk Adjustment coding of medical records. Track… more
- University of Utah Health (Murray, UT)
- …integrity, quality and trust that are integral to our mission. EO/AA_ + Risk Adjustment Analyst position provides support for our health plan's risk ... or related field. + 2+ years of experience in risk adjustment analytics within a health...sexual misconduct including sexual harassment, you may contact the Director /Title IX Coordinator in the Office of Equal Opportunity… more
- Evolent (Phoenix, AZ)
- …member contributes to providing better health outcomes for the population. The Risk Adjustment Coding Manager plays a crucial role in ensuring accurate ... health care providers on clinical documentation requirements, risk adjustment coding guidelines, and updates. +...coding questions and issues. + Collaborate with the coding director to develop policies, procedures, and workflows to enhance… more
- Commonwealth Care Alliance (Boston, MA)
- … Director of Encounter Data Management within the Revenue Cycle Department, the Risk Adjustment Data Developer is responsible for the design, development, and ... of data systems and tools that support Commonwealth Care Alliance's (CCA) risk adjustment and Hierarchical Condition Category (HCC) revenue programs. This… more
- CareFirst (Baltimore, MD)
- … Analytics team is hiring a lead data analyst with deep experience in risk adjustment . This person will support the Director of Risk Adjustment by ... monitoring and reporting on risk adjustment KPIs, delivering insights for prospective and retrospective ...him/her ineligible to perform work directly or indirectly on health care programs. **PHYSICAL DEMANDS:** The associate is primarily… more
- OhioHealth (Columbus, OH)
- …is responsible for the strategic coordination of quality and risk adjustment programs supporting OhioHealth's Population Health efforts including but not ... **We are more than a health system. We are a belief system.** We...40% Responsible for the daily operations and supervision of Risk Adjustment & Quality programs; works with… more
- New York State Civil Service (Albany, NY)
- NY HELP No Agency Financial Services, Department of Title Financial Crimes Risk Manager ( Director Financial Services Programs 1, SG-31) Occupational Category ... consumers and protecting them from financial harm; ensuring the health of the entities we regulate; driving economic growth...is seeking candidates for the position of Financial Crime Risk Manager, ( Director Financial Services Programs 1),… more
- Mount Sinai Health System (New York, NY)
- …driving key population health goals including access, quality, utilization and accurate risk adjustment with a group of practices and (2) close partnership ... **Job Description** **Mount Sinai Health System is seeking a Medical Director...with the CDQI Director to drive accurate risk ...with the CDQI Director to drive accurate risk adjustment throughout the system. This Medical… more
- Martin's Point Health Care (Portland, ME)
- …of ACOs and contributes to their management and strategic deployment. + Provides support to Health Plan risk adjustment activities as needed. + Is conversant ... clinical programming, quality management, and external relationships. The Medical Director reports to the Vice President Health ...Medical Director reports to the Vice President Health Plan Medical Director and works closely… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …RSA initiatives, including Hierarchical Condition Categories (HCC) coding and other risk adjustment payment models. This role strategizes and collaborates ... At Bon Secours Mercy Health , we are dedicated to continually improving ...for performance improvement related to system-wide HCC and other risk adjustment coding initiatives. Conducts medical record… more
- Saint Francis Health System (Tulsa, OK)
- …Population Health 's clinical teams including quality, care management, pharmacy, risk adjustment program, and post-acute care initiatives. Reviews quality ... Only: 12-16 hours per week Job Summary: The Medical Director , Population Health (H) serves as the...Community Care of Oklahoma, Medicare ACO, Saint Francis's employer-sponsored health plan, and other at risk contracts.… more
- Elevance Health (Grand Prairie, TX)
- …Capabilities and Experiences:** + Deep understanding of CMS-HCC and/or HHS-HCC risk adjustment methodologies strongly preferred. + Experience partnering with ... **Clinical Compliance Medical Director ** _Please note that per our policy t_...regulatory, compliance, and legal matters strongly preferred. + Certified Risk Adjustment Coder (CRC) or similar credential… more
- Scripps Health (San Diego, CA)
- …Categories (HCCs) for accuracy and compliance as relates to Outpatient CDI. Monitors Risk Adjustment Factor (RAF) Scores. * Directs instructions and education ... accountability for the oversight of Coding, Clinical Documentation Integrity (CDI) and Health Information Management HIM. The Senior Director manages the staff… more
- University of Utah (Salt Lake City, UT)
- …Director of Student Support. Using a broad knowledge base of mental health issues, behavioral risk assessment, crisis intervention skills, and student ... **Open Date** 07/09/2025 **Requisition Number** PRN42423B **Job Title** Associate Director , Student Services **Working Title** Associate Director , Student… more
- Tufts Medicine (Boston, MA)
- …of Department of Medicine strategies with network and payer priorities. 10. Supports risk adjustment , care model design, and other payer-facing initiatives. 11. ... Performance Metrics (eg, HEDIS, Stars, and clinical outcomes). b.) 25% - Risk Adjustment (accurate RAF coding, documentation, and patient complexity). c.)… more