- 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....Director of Medicare Risk Adjustment and Analytics. This role will... performance that will assess the progress of the risk adjustment strategy + Develop… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …The role is responsible for the strategy , execution and performance of Medicare risk adjustment reporting and analytics, infrastructure and systems to ... Bring your true colors to blue. Under the direction of the Senior Directory of Medicare Risk Adjustment and Analytics, the Director of Risk Adjustment… more
- Blue KC (Kansas City, MO)
- … adjusted revenue optimization strategy and oversight of Government Programs Risk Adjustment programs. **Job Description** + Interface with Blue KC ... and quality coding. + Provide Government Programs oversight to ensure Medicare Advantage and ACA Risk Adjustment and state regulations are maintained. +… 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 ... financial returns in a fully compliant manner. Develop a Risk Management governance strategy for the Enterprise...Management: + Provide strategic leadership and management for the Risk Adjustment Accuracy Management Department. + Develop… more
- CareFirst (Baltimore, MD)
- …are: direct and indirect reports and vendors. Prioritize work in alignment with Risk Adjustment strategy , business goals, organizational strategies and ... oversees the outcomes and operations of risk adjustment across the organization within Medicare Advantage, Medicaid & ACA markets. The Risk … more
- Datavant (Lincoln, NE)
- …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 actionable… more
- Datavant (Trenton, NJ)
- …+ Knowledge and understanding of HCC mapping and models + Experience with coding Medicare , Commercial and Medicaid risk adjustment charts + Understanding of ... Medicare , Commercial and Medicaid risk adjustment business logic and coding +...other legally protected status. At Datavant our total rewards strategy powers a high-growth, high-performance, health technology company that… 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 ... vision for healthcare. **What we're looking for:** The incoming Risk Adjustment Analytics Manager will be stepping...with other managers and the department director to set strategy and mobilize the team to be as performant… 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...Chief Actuary to lead unit development and execution of strategy through tactics, actions, processes, plans, and analytical tools… more
- Centene Corporation (Providence, RI)
- … Medicare contract models, incorporating CMS and NYSDOH guidelines related to risk adjustment , quality metrics, and financial benchmarks. + Collaborate with ... with Contract management and Service Fund teams to implement monitoring of Medicare -specific VBP contracts, including models with upside/downside risk , shared… more
- Molina Healthcare (ID)
- …Azure, AWS, or Hadoop + 3-5 years of experience in Analysis related to HEDIS and/or Risk Adjustment + 3-5 years of experience in working with complex data to ... Educates users on how to use reports related to Risk and Quality/HEDIS for Medicaid, Marketplace and Medicare...users on how to use reports + Builds intervention strategy reporting for the Risk and Quality… more
- Molina Healthcare (Madison, WI)
- …+ Establishes strategy and operational direction for engaging providers on risk adjustment & quality improvement in collaboration with the Plan President, ... , and Network team. + Collaborates with Health Plan Network to drive value-based care strategy related to risk adjustment & quality. + Sets Health Plan… more
- CenterWell (Des Moines, IA)
- …within the Primary Care Organization. ** Strategy :** + In partnership with AVP, Risk Adjustment and AVP, MRA Strategy , responsible for driving ongoing ... Documentation (APD) tool) + Responsible for performance management and strategy development for PCO risk adjustment...up to 20% **Preferred Qualifications** + Proven experience with Medicare Advantage risk adjustment functions.… more
- Molina Healthcare (Syracuse, NY)
- …Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Ensures the ... Plan have engagement plans to meet annual quality and risk adjustment goals. Drives coaching and collaboration...Min 3 years experience improving Quality performance for Medicaid, Medicare , and/or ACA Marketplace programs To all current Molina… 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
- Humana (Denver, CO)
- …in a health care and / or Insurance setting + Working knowledge of Medicare Risk Adjustment and/or Stars + Experience utilizing Articulate products ... solutions are necessary or relevant. Begins to influence department's strategy . Makes decisions on moderately complex to complex issues...Information** This role will be responsible for supporting the Medicare Risk Adjustment Team within… more
- CenterWell (Phoenix, AZ)
- …care, especially Medicare Advantage, with familiarity of HEDIS/STARS, medical risk adjustment , and clinical programming in primary care, complex care, ... strong emphasis on senior-focused primary care for members of Medicare Advantage health plans and is committed to providing...develop and support the MSO's National Clinical Vision and Strategy , directly lead a team of regional & area… more
- CenterWell (Jacksonville, FL)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... organizational & market priorities, trends, and goals, to develop a clinical strategy to advance clinical talent and performance + Interview, hire, and supervise… more
- Datavant (Providence, RI)
- …outpatient or inpatient setting. + Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment , CDI, Medicaid, Commercial RA, and HEDIS ... up to date with current coding policies for ICD-10, Medicare Advantage, HHS (ACA), and other markets. + Provide...clients understand the shifts and trends happening in the risk adjustment coding space. **What you will… more