- Somatus (Mclean, VA)
- Overview The Director , Medicare Risk Adjustment (MRA) will lead the execution strategy and implementation of the organization's Risk Adjustment ... customer service, enrollment etc. + Proven experience with commercial and/ or Medicare Advantage risk adjustment functions. + Proven track record of working… more
- CVS Health (Jackson, MS)
- …to make health care more personal, convenient and affordable. As the Senior Manager, Risk Adjustment ( Medicare ) will be responsible for leading Risk ... Adjustment for the Georgia & the Gulf States Medicare Market, specifically in Mississippi. This role will have...working with providers. This position reports to the Lead Director of Risk Adjustment for… more
- CVS Health (Atlanta, GA)
- …to make health care more personal, convenient and affordable. As the Senior Manager, Risk Adjustment ( Medicare ) will be responsible for leading Risk ... Adjustment for the Georgia & the Gulf States Medicare Market. This role will have specific responsibility for...working with providers. This position reports to the Lead Director of Risk Adjustment for… more
- Henry Ford Health System (Troy, MI)
- The Director of Risk Adjustment & Value Based Payment is an unparalleled opportunity with Henry Ford Health. This pivotal role spearheads strategic endeavors ... value-based care. Join us in revolutionizing healthcare delivery! The Director of Risk Adjustment and...successful in its participation in alternative payment models, including risk adjusted contracts, Medicare Shared Savings Program… more
- Martin's Point Health Care (Portland, ME)
- …refinement, maintenance, monitoring and oversight of Medicare Risk Adjustment initiatives and operations. The Senior Director is also responsible for ... been certified as a "Great Place to Work" since 2015. Position Summary The Senior Director of Risk Adjustment Operations in our Health Plan is responsible… more
- Trinity Health (Fort Lauderdale, FL)
- …Expertise in Medicare programs and regulations including fraud and abuse and Medicare Hierarchical Condition Coding Risk Adjustment + Excellent analysis ... or perform data mining and data-driven analysis to forecast/evaluate the performance of the risk adjustment program and refine annual risk adjustment … more
- CareOregon (Portland, OR)
- … Adjustment Analytics Manager Exemption Status Exempt Department Finance Manager Title Director , Risk Adjustment Direct Reports Risk Adjustment ... development, execution, and management of the risk adjustment data analytics programs for the Medicare ...Responsibilities Technical and Operational Management + Work with the Director of Risk Adjustment in… more
- Centene Corporation (Raleigh, NC)
- …as a medical coder. Required 2+ years of experience in coding with knowledge of Medicare risk adjustment (HCC Coding). Required Other experience in teaching, ... 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
- Molina Healthcare (Long Beach, CA)
- …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
- CVS Health (Hartford, CT)
- …years of relevant financial experience + Knowledge of: Financial Management, Expense Management, Medicare Bids, Stars, Risk Adjustment + Skill In: Ability ... Integrity teams for each of the 4-5 regions that Medicare operates under. This organization will help strengthen the...business partners the expansion of VBC, Provider Collaboration (ie Risk deals) across the local markets. Ensure deals are… more
- CareOregon (Portland, OR)
- …+ Knowledge of Medicare Advantage bid process + Understanding of various risk adjustment methodologies (eg CDPS+Rx, CMS-HCC, ACG, ERG, MARA) + Strong ... Advantage bid; advise internal leadership on potential bid pricing strategies. + Collaborate with Risk Adjustment team to monitor risk adjustment applied… more
- The Cigna Group (Miramar, FL)
- …experience or direct health plan experience with STARS, HEDIS, Risk Adjustment and medical expense reduction, specific to Medicare Advantage required + ... Market Provider Performance, Sales, Health Services, Clinical, Stars & Risk Adjustment , Finance, Marketing, Cross-Segment Contracting, Provider Relations,… more
- Elevance Health (Columbus, OH)
- …faith-based, community-based, and special needs initiatives. + Oversee Stars and Risk Adjustment performance and local market strategies with providers ... a check, or ask you for payment as part of consideration for employment. **RVP Medicare Market President (OH)** + Job Family: BUS > Strategy, Planning & Execution +… more
- Elevance Health (Middletown, NY)
- …faith-based, community-based, and special needs initiatives. + Oversee Stars and Risk Adjustment performance and local market strategies with providers ... or ask you for payment as part of consideration for employment. **RVP Medicare Market President (Northeast)** + Job Family: BUS > Strategy, Planning & Execution… 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
- 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 (Albuquerque, NM)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... **REQUIRED EXPERIENCE:** * 5 years previous experience as a Medical Director in clinical practice * 3 years' experience in Utilization/Quality Program… more
- Centene Corporation (Jefferson City, MO)
- …and Information Set (HEDIS) performance + Responsible for quality improvement aspects of risk adjustment processes for all products + Collaborate with ... benefits including a fresh perspective on workplace flexibility. Supporting** ** Medicare STARS **Position Purpose:** Lead and direct process improvement activities… more