- Elevance Health (Smithfield, RI)
- ** Medicare Risk Adjustment Actuarial Analyst III** **On-Site Requirement: Hybrid 1;** **This role requires associates to be in-office 1 - 2 days per ... for employment, unless an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Actuarial Analyst III** is responsible for… more
- CVS Health (Providence, RI)
- …regulatory compliance. + Serve as a subject matter expert on CMS regulations, risk adjustment , and revenue optimization. + Collaborate with internal stakeholders ... CMS Part C/D operations. + 5+ years' experience working with CMS regulations, risk adjustment methodologies, and revenue management. + 5+ years' experience… more
- Datavant (Providence, RI)
- …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 ... 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
- Centene Corporation (Providence, RI)
- … Medicare contract models, incorporating CMS and NYSDOH guidelines related to risk adjustment , quality metrics, and financial benchmarks. + Collaborate with ... management and Service Fund teams to implement monitoring of Medicare -specific VBP contracts, including models with upside/downside risk...internal teams (eg, Actuarial , Clinical, Legal, and Provider Relations) to align on… more
- Evolent (Providence, RI)
- …of Medicare claims, episode and condition groupers, case/episode and risk adjustment , patient attribution methodologies, and network analysis and pod ... + Bachelor's degree, preferably with a quantitative major (eg actuarial , statistics, biostatistics, operations research, mathematics, economics) or healthcare major… more