- 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...limited to HAP, physician leadership, administration, operations, finance, IT, managed care, and human resources to meet project goals.… more
- Martin's Point Health Care (Portland, ME)
- …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 ... maintenance, monitoring and oversight of Medicare Risk Adjustment initiatives and operations. The Senior Director ...Degree + 10 years of experience in health care, managed care, health insurance or strategic consulting + and… more
- Centene Corporation (Raleigh, NC)
- …medical record audits, analysis of practice coding patterns, education and training regarding risk adjustment to ensure accurate CMS payment and improve quality ... and market level. + Subject matter experts for proper risk adjustment coding and CMS data validation...include Provider Relations, Quality as well as the Medical Director for the state assigned to ensure compliance of… more
- RWJBarnabas Health (Somerset, NJ)
- …and Health System in various area, inclusive of general contracting, quality, risk adjustment , and other discussion/initiatives + Assist with other various ... Director Population Health- Accountable Care Organization- Somerset, NJReq...monitor and improve performance for their MSSP, Commercial, and Managed Care populations. Qualifications: Required + Bachelor's Degree, required… more
- CVS Health (Columbus, OH)
- …treatment protocols for DSNP/MMP and other complex health populations to optimize risk adjustment , clinical quality, and care management* Actively participate in ... of clinical initiatives and programs to address the needs of the populations managed to improve health outcomes* Leverage extensive knowledge of health care delivery… more
- Walmart (Bentonville, AR)
- …for the development and delivery of provider education and training as assigned, including risk adjustment , quality, focus on care, and optimal care. + Develops ... Prior working experience in educational training content, Sharepoint, or LMS systems., Risk adjustment or quality. **Primary Location ** 2608 Se J… more
- Molina Healthcare (Long Beach, CA)
- …regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare, Medicaid,… more
- Molina Healthcare (Albuquerque, NM)
- …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
- Molina Healthcare (Albuquerque, NM)
- …regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare, Medicaid,… more
- Actalent (Boston, MA)
- **IMMEDIATE NEED FOR PERMANENT DIRECTOR OF CLINICAL OPERATIONS OPPORTUNITY WITH AN ESTABLISHED ONCOLOGY PHARMA** Responsibilities: + Align with the Head of Clinical ... according to the agreed project plan. Complete a study risk assessment and ensure mitigation and contingency measures are...unwarranted change orders) and budget, so both can be managed appropriately. + People and Resource Management + Responsible… more
- VIP Care (Tampa, FL)
- …Medical Record (EMR) system to review Patient records + Proficiency in Medicare Risk Adjustment + Effective communication and interpersonal skills + Proficiency ... Summary/Objective: The Senior Medical Director is responsible for leading efforts to develop...of clinical experience + 3 or more years of managed care experience + Experience in Utilization Management and… more
- Bristol Myers Squibb (Devens, MA)
- …lives. Read more: careers.bms.com/working-with-us . Position Summary: The Associate Director Supplier Relationship Manager (SRM) is accountable for overall ... network partners are identified at the right time and managed to assure robust supply of BMS cell and...CMOs with focus on creating the agility, flexibility, and risk -sharing frameworks to support the fluidity associated with novel… more
- Providence (Portland, OR)
- …achieving organizational results in value-based programs including, but not limited to, Risk Management, Contract Management, Risk Adjustment Scoring, ... **Description** The Executive Director is responsible for the overall strategy and...10 years of senior leadership experience with a health insurance/ managed care organization, clinically integrated network (CIN), or independent… more
- CareOregon (Portland, OR)
- …Advantage bid; advise internal leadership on potential bid pricing strategies. + Collaborate with Risk Adjustment team to monitor risk adjustment applied ... processes + Knowledge of Medicare Advantage bid process + Understanding of various risk adjustment methodologies (eg CDPS+Rx, CMS-HCC, ACG, ERG, MARA) + Strong… more
- AdventHealth (Shawnee, KS)
- …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...substance use and addictive disorders + Provides patient/family education, adjustment -to-illness counseling, grief counseling and crisis intervention + Provides… more
- AdventHealth (Altamonte Springs, FL)
- …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...discharge planning, utilization management, care management, performance improvement and managed care reimbursement Knowledge of state and federal guidelines… more
- AdventHealth (Glendale Heights, 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
- Loretto Management Corporation (Syracuse, NY)
- …assists in analysis as appropriate. Acts as back up person for completion of risk adjustment reports. + Monitors compliance with procedures relevant to clinical ... the general direction and supervision of the Health Information Director /Designee, the Compliance Reimbursement Specialist is responsible for analyzing documented… more
- Baptist Memorial (Memphis, TN)
- …integrity of upstream, midstream and downstream revenue cycle activities that impact the adjustment processing of claims. + Conducts risk assessments to define ... claims. This role requires thorough understanding of regulatory requirements, managed care contract terms, facility-specific internal guidelines, revenue integrity,… more
- Kelsey-Seybold Clinic (Houston, TX)
- …Part C or Health Insurance Marketplaces highly desirable, particularly with CMS risk adjustment models. Experience in the healthcare industry with understanding ... of a team of 1-3 analysts and closely collaborate with the Manager and Director of Healthcare Finance to oversee and provide financial data, reporting and other… more