• AVP, Quality & Risk

    Molina Healthcare (Ridgeland, MS)
    **Job Description** **Job Summary** The AVP, Quality & Risk Adjustment is responsible for leading health plan execution for Risk Adjustment and ... of strategy and activities with Enterprise, acting as the Risk Adjustment and Quality subject... Provider Engagement team for large, contracted, value-based provider systems. + Attends state and regional Quality more
    Molina Healthcare (09/25/25)
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  • Quality & Risk Adjustment

    Blue Cross and Blue Shield of Minnesota (Eagan, MN)
    …Blue Cross and Blue Shield of Minnesota Position Title: Quality & Risk Adjustment Provider Consultant Location: Hybrid | Eagan, Minnesota Career ... -performance consultation team, this role * Identifies opportunities for provider groups to improve performance on quality ...-facing or leadership-facing experience * Knowledge of Health Care Quality measures * Certified Risk Adjustment more
    Blue Cross and Blue Shield of Minnesota (09/30/25)
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  • Manager, Quality and Risk

    OhioHealth (Columbus, OH)
    …- in our careers and in our communities. **Job Description Summary:** The Manager, Quality & Risk Adjustment is responsible for the strategic coordination ... of quality and risk adjustment programs supporting OhioHealth's Population Health...with frequently include but are not limited to: PHS Provider & Practice Engagement, PHS Value-based Contract team, Care… more
    OhioHealth (09/27/25)
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  • Program Manager - Provider Engagement,…

    Molina Healthcare (St. Petersburg, FL)
    …**Program Manager - Provider Engagement** plays a key role in driving risk adjustment and quality performance outcomes through effective program ... templates, talking points, and guidelines for external stakeholders. + Provide responsive support to provider and partner...payer- provider program management. + Familiarity with clinical, quality , or risk adjustment program… more
    Molina Healthcare (08/31/25)
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  • Risk Adjustment Coder-6

    ChenMed (Miami, FL)
    …departments to review medical records and other clinical documentation to identify appropriate risk adjustment codes and quality gap closure opportunities. A ... to collect and review documents to support the organization's quality and risk adjustment initiatives,...is unsubstantiated by the record should be queried to provider and assess to accuracy. + Reviews for clinical… more
    ChenMed (10/03/25)
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  • Lead Data Analyst, Medicare Risk

    CareFirst (Baltimore, MD)
    …make informed decisions and assist the organization in making better business decisions. The Quality , Stars, and Risk Adjustment Analytics team is hiring a ... lead data analyst with deep experience in risk adjustment . This person will support the...the design, development, validation and delivery of data to provide insight into business decisions. + Act as a… more
    CareFirst (08/19/25)
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  • Risk Adjustment QA Consultant

    Blue Cross and Blue Shield of Minnesota (Eagan, MN)
    …are ready to make a difference, join us. The Impact You Will Have As a Risk Adjustment Quality Assurance (QA) Consultant at BCBSMN, you'll play a critical ... protected characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Risk Adjustment QA Consultant Location: Hybrid | Eagan, Minnesota Career… more
    Blue Cross and Blue Shield of Minnesota (09/10/25)
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  • Senior Specialist, Provider Engagement…

    Molina Healthcare (Syracuse, NY)
    …role implements Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider ... providers have a Provider Engagement plan to meet annual quality & risk adjustment performance goals. * Drives provider partner coaching and… more
    Molina Healthcare (10/03/25)
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  • Director Risk Adjustment , Coding…

    Highmark Health (Pittsburgh, PA)
    Quality and Coding for the Highmark Health Enterprise. Ensures that Highmark's Risk Adjustment programs comply with all applicable guidelines, regulations and ... employees that are health plan and community-based (embedded into provider systems) to deliver the highest quality ...a team of internal coder / clinicians that perform Risk Adjustment coding of medical records. Track… more
    Highmark Health (08/08/25)
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  • Quality Practice Advisor

    Centene Corporation (Springfield, IL)
    …federal, and NCQA requirements. + Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and ... to improve provider performance in areas of Quality , Risk Adjustment and Operations...encounters). + Identifies specific practice needs where Centene can provide support. + Develops, enhances and maintains provider more
    Centene Corporation (09/13/25)
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  • Quality Practice Advisor

    Centene Corporation (Fort Myers, FL)
    …federal, and NCQA requirements. + Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and ... to improve provider performance in areas of Quality , Risk Adjustment and Operations...encounters). + Identifies specific practice needs where Centene can provide support. + Develops, enhances and maintains provider more
    Centene Corporation (09/24/25)
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  • Provider Engagement Manager (Remote in New…

    Molina Healthcare (New York, NY)
    …Manager implements Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider ... a Provider Engagement plan to meet annual quality & risk adjustment performance... provider partner coaching and collaboration to improve quality performance and risk adjustment more
    Molina Healthcare (09/25/25)
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  • Specialist, Provider Engagement (Remote…

    Molina Healthcare (Longview, TX)
    …role implements Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider ... providers have a Provider Engagement plan to meet annual quality & risk adjustment performance goals. * Drives provider partner coaching and… more
    Molina Healthcare (09/17/25)
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  • Coder

    Dignity Health (Bakersfield, CA)
    …DHMSO and its clinical integrated networks throughout to identify opportunities for improved quality , risk adjustment coding performance. The Value Based ... owned by Dignity Health. As a member of the Quality Management/ Risk team, the Value Based Coder...and review network coding opportunities as it pertains to risk adjustment . - Ensure that the diagnosis… more
    Dignity Health (10/02/25)
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  • Risk Adjustment Analyst, Health…

    University of Utah Health (Murray, UT)
    …clinical, coding, and IT teams to ensure compliance, optimize risk adjustment revenue, and help drive provider engagement interventions. **Qualifications** + ... business (eg, ACA, Medicaid). + Supports the evaluation of risk adjustment interventions such as provider... quality . + Demonstrated knowledge with the specific risk adjustment models. HHS HCC, CMS HCC… more
    University of Utah Health (10/03/25)
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  • Senior Risk Adjustment Analyst- ACA…

    CareFirst (Baltimore, MD)
    …schedule for delivering results of analyses to improve awareness and understanding of risk adjustment results and quality , accuracy and identification of ... solve problems, provide data-driven guidance, and monitor risk adjustment performance. Provide analytical...developing materials and presenting key updates to leadership regarding risk adjustment programs and provider more
    CareFirst (09/26/25)
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  • Risk Adjustment Coding Coordinator…

    Excellus BlueCross BlueShield (Rochester, NY)
    …and coding policies to ensure accurate diagnosis coding. This position is responsible for risk adjustment coding and quality assurance validation for the ... processing / adjustment area ( Risk Adjustment /Actuarial Services). * Performs vendor Quality Assurance...liaison between the Plan and designated representatives of the provider office and/or hospitals and vendor(s) in aspects of… more
    Excellus BlueCross BlueShield (08/27/25)
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  • Risk & Quality Performance Manager…

    Molina Healthcare (Kearney, NE)
    …but not limited to: Risk / Quality rate trending and forecasting; provider Risk / Quality measure performance, CAHPS and survey analytics, health equity ... & ABILITIES:** * 2+ years of program and/or project management experience in risk adjustment and/or quality * 2+ years of experience supporting HEDIS engine… more
    Molina Healthcare (09/19/25)
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  • Associate Director, Clinical Data Management

    Blue Cross Blue Shield of Massachusetts (Boston, MA)
    …of high- quality , trustable clinical data to support key initiatives around quality , risk adjustment , medicare stars, and interoperability. This is ... + Collaborate with cross-functional teams, including clinical operations, performance measurement, and risk adjustment , to execute on data procurement & usage… more
    Blue Cross Blue Shield of Massachusetts (09/25/25)
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  • Medical Director Physician Engagement and CDQI…

    Mount Sinai Health System (New York, NY)
    …CDQI, who will (1) be responsible for driving key population health goals including access, quality , utilization and accurate risk adjustment with a group of ... and research/education. We have ~40,000 employees working together to provide billions of dollars in high- quality care...hardwiring processes to drive excellence in efficiency of care, quality and accurate risk adjustment more
    Mount Sinai Health System (09/01/25)
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