- 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
- CVS Health (Phoenix, AZ)
- …has an exciting opportunity for an Informatics Manager to join our dynamic Risk Adjustment Analytics team! In this role, you will support data analysis, ... predictive modeling, and evaluation reporting within our Medicaid lines of business. The position will involve extracting,...Knowledge of health insurance concepts - Experience working in risk adjustment - Experience working at a… 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
- Providence (Portland, OR)
- …Direct Commercial pricing, rate setting and rate filing, forecasting, budgeting, and estimating risk adjustment and risk transfer payment amounts. + ... **Description** **Senior Manager Actuarial Analytics \*Remote * Candidates residing in...Medicare Advantage Bid + Experience with Commercial, Medicare, and Medicaid revenue methodologies. + Demonstrated experience with managing professional… more
- Commonwealth Care Alliance (Boston, MA)
- …as a resource for primary care site to answer questions regarding risk adjustment , corrective CPT coding, Medicare & Medicaid coding guidelines and updates + ... (CCS, CCS-P, CCA from AHIMA) or Certified Professional Coder (CPC), and Certified Risk Adjustment Coder (CRC) from the American Association of Professional… 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
- CVS Health (Austin, TX)
- …have knowledge of Value Based Care, Medicare Advantage, Quality & Clinical Programs, Risk Adjustment , EHR technology and have a wholehearted interest in diving ... looking for a dynamic, passionate, and experienced Senior Product Manager to join the Signify Health team to help...into requirements and lead team through execution focused on Medicaid , virtual visits and member experience + Develop a… 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
- Hartford HealthCare (Farmington, CT)
- …and education specialist will support documentation practices that comply with CMS risk adjustment program requirements and ICD 10 coding guidelines. Reporting ... to Manager of Audit and Education *_Position Responsibilities:_* *Key Areas...6. Identify process improvements to capture data for Medicare Risk Adjustment and help providers code to… 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
- CenterLight Health System (NY)
- …physician practices on current performance. + Serves as a subject matter expert on Risk Adjustment Data Validation (RADV) audits from Medicare. + Perform random ... for reviewing and implementing accurate medical/coding policies and Claims Manager edits across all PACE sites and other entities.... (CPPM) 4. Certified Professional Biller (CPB) 5. Certified Risk Adjustment Coder (CRC). Experience: + Three… 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