- Somatus (Mclean, VA)
- …teammates physical and mental well-being + Community engagement opportunities + And more! The Director , Medicare Risk Adjustment (MRA) will lead the ... customer service, enrollment etc. + Proven experience with commercial and/ or Medicare Advantage risk adjustment functions. + Proven track record of working… more
- Centene Corporation (Columbia, SC)
- …as a medical coder 2+ years of experience in coding with knowledge of Medicare risk adjustment (HCC Coding) Required Other experience in teaching, ... include Provider Relations, Quality as well as the Medical Director for the state assigned to ensure compliance of...2+ years of experience in coding with knowledge of Medicare risk adjustment (HCC Coding)… more
- Centene Corporation (Yuma, AZ)
- …1+ years of experience in medical records coding (HCC Coding) with knowledge of Medicare , Marketplace, and Medicaid risk adjustment is required. Provider ... analysis of practice coding patterns, education and training regarding risk adjustment to ensure accurate CMS payment...include Provider Relations, Quality as well as the Medical Director for the state assigned to ensure compliance of… more
- Centene Corporation (Carson City, NV)
- …as a medical coder. 2+ years experience in coding with knowledge of Medicare risk adjustment (HCC Coding). Required experience- teaching, training ... analysis of practice coding patterns, education and training regarding risk adjustment to ensure accurate CMS payment...include Provider Relations, Quality as well as the Medical Director for the state assigned to ensure compliance of… more
- Henry Ford Health System (Troy, MI)
- … payment models and other value based initiatives. Under minimal supervision from the Director , Risk Adjustment and Value Based Payment, the Manager is ... The Manager, Risk Adjustment & Value Based Reimbursement...both departmental staff and multi-disciplinary teams. + Knowledge of Medicare , Medicaid, Blue Cross and other third party payers… more
- Elevance Health (Richmond, VA)
- …practice managers, population health and quality directors on improving STARS/HEDIS or Risk Adjustment performance. + Six Sigma or formal process improvement ... a proud member of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also provide administrative services to Medicaid… more
- Universal Health Services (Reno, NV)
- …programs. + At least 3 years of health care experience working with Medicare and/or Commercial risk adjustment programs. Requires working knowledge ... strategies within the Prominence Health umbrella. Emphasis will be centered around risk -based contract performance, risk adjustment , and quality measurement… more
- The Mount Sinai Health System (New York, NY)
- …adjustment with a group of practices and (2) close partnership with the CDQI Director to drive accurate risk adjustment throughout the system. This ... the status quo **Role Summary:** MSHP seeks a Medical Director (MD), Physician Engagement and CDQI, who will (1)...drive excellence in efficiency of care, quality and accurate risk adjustment for all populations served, especially… more
- Providence (Portland, OR)
- …Demonstrated expertise in budgeting and forecasting techniques. + Demonstrated knowledge in risk adjustment models (commercial, ACA, Medicare , and Medicaid) ... budgeting, projecting provider risk sharing and alternative payment amounts, and estimating risk adjustment and risk transfer payment amounts. + Key… more
- Mitsubishi Chemical Group (Jersey City, NJ)
- …on real-world evidence, and creating hope for all facing illness. The Director , Government Accounts will be responsible for the development and implementation of ... imperatives and tactical planning for targeted government channels: CMS, Medicare Part B MAC's, VA, DOD and Tricare East...pull through with the field Sales and Marketing. The Director , Government Accounts will maintain a high level of… more
- VIP Care (Tampa, FL)
- …Electronic Medical Record (EMR) system to review Patient records + Proficiency in Medicare Risk Adjustment + Effective communication and interpersonal skills ... Summary/Objective: The Senior Medical Director is responsible for leading efforts to develop...performance improvement strategies to ensure success in our existing ( Medicare Advantage) as well as net new LOBs. They… more
- Molina Healthcare (Bothell, WA)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare ,… more
- Commonwealth Care Alliance (Boston, MA)
- …activities and reviews, including claims reviews; call center and digital communications reviews; Medicare Risk Adjustment , HCC, clinical and coding reviews; ... This Role is Important to Us:** **Position Summary:** The Director , Quality & Control Assurance reports to the VP...of Quality & Control Assurance policies & procedures, SOPs, risk assessments, and work plans. + Provides clear and… more
- Molina Healthcare (Albuquerque, NM)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in Utilization/Quality Program… more
- Evolent Health (Columbus, OH)
- …analytics to drive decision making and with Hierarchical Condition Category Risk Adjustment - **Preferred** . + Leadership/ mentoring experience supporting ... as we solve complex business problems. **Collaboration Opportunities:** The Director , Actuarial utilizes and develops analytical tools to solve complex… more
- AdventHealth (Hinsdale, IL)
- …coordinates and facilitates the development of a discharge plan of care for high- risk patient populations. This role will receive referrals for individuals from at- ... risk populations from interdisciplinary team members (including physicians, RN Care Managers, staff nurses, and other members of the care team). The Social Work Care… more
- St. Luke's University Health Network (Allentown, PA)
- …to: RN care managers, assistants, coordinators, utilization management staff, and director . + Facilitates communication among all treatment team members. + Manages ... patient as healthy as possible in the outpatient setting, minimizing the risk of readmissions. + Issues applicable state/federal regulatory notices as applicable… more
- Humana (Columbus, OH)
- …Network Optimization, Clinical Services, Value-Based contracting, HEDIS and Risk Adjustment . Reporting to the Associate Director and/or Market Development ... the health plan, physician, providers and practice managers. + Supporting HEDIS & Risk Adjustment initiatives and Ohio Department of Medicaid quality initiatives… more
- Bausch Health (Bridgewater, NJ)
- …people's lives with our health care products. Reporting to the Senior Director , Finance (Revenue & GTN Accounting), the Senior Manager, Finance Commercial Contracts ... is responsible for managing and accounting for Commercial and Medicare Part D contracts and will oversee the daily...controls and compliance environment including the maintenance of the risk control matrix, audit support, and the periodic SOX… more
- Commonwealth Care Alliance (Boston, MA)
- …+ Maintain current industry knowledge of highly impactful external audits such as Risk Adjustment Data Validation Audit, CMS Program Audit protocols, common ... Risk Assessment. + Make recommendations towards enhancements to the Continuous Compliance Risk Assessment process. + Alert Director of Internal Audit of… more