• Director , Risk Adjustment

    Centene Corporation (Sunrise, FL)
    Professional Position Purpose: The Director , Risk Adjustment is a key strategic leader responsible for driving the Risk Adjustment for various lines ... relates to Risk Adjustment , Clinical Risk Groups and Quality initiatives. Use analytics ...least two years of experience with Risk Adjustment . Experience at a Manager or Director more
    Centene Corporation (06/18/20)
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  • Director , Quality & Risk

    Lumeris (St. Louis, MO)
    …having to re-enter information. Thank you for your interest in Lumeris. **Position:** Director , Quality & Risk Adjustment , PHSO **Position Summary:** The ... Director , Quality & Risk Adjustment , PHSO serves as the organizational...opportunities for enhancement of Lumeris solutions and capabilities (technology, analytics , and services) Internal Operations + Oversee the execution… more
    Lumeris (04/22/20)
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  • Senior Medicare Risk Adjustment

    Humana (Phoenix, AZ)
    …+ Monitor KPIs through analytics and identify providers for Medicare Risk Adjustment training, programs and documentation/coding resources + Provide ICD10 - ... Description Senior Medicare Risk Adjustment /Documentation & Coding Professional:Our search...and accurate coding. This role reports to the MRA Director and as a member of the MRA team… more
    Humana (06/19/20)
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  • Analyst, Quality/ Risk Adjustment

    Steward Health Care System (Needham, MA)
    …analysis, and information services. Position Purpose: Reporting to the Director of Analytics , the Analyst, Quality/ Risk Adjustment will work in tandem ... for appropriate quality measures across all Steward Commercial, Medicare and Medicaid risk contracts + Collaborate with the Performance Ops Quality team to provide… more
    Steward Health Care System (05/13/20)
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  • Director , Risk Management- Texas

    Humana (Dallas, TX)
    …regionally-based risk adjustment activities + Work cross-functionally to establish risk adjustment analytics such as predictive modeling for coding ... Description The Director , Risk Management leads the regional...& oversight are: + Evaluation and analysis of Medicare Risk Adjustment opportunity; + Designing and executing… more
    Humana (06/27/20)
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  • Director , Data Validation (Rate Advocacy)

    Centene Corporation (Harrisburg, PA)
    …Analyze regulations and provide recommendations for optimization of current rates. Manage analytics for risk adjustment . Partners closely with Actuarial ... impact Drive vendor strategy on records and data validity to minimize risk adjustment liabilities Develop an analytical strategy to make recommendations… more
    Centene Corporation (05/08/20)
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  • Asscociate Director -Commercial Healthcare…

    Guidehouse (Washington, DC)
    …capitation rate-setting, determining and measuring managed care plan effectiveness, risk - adjustment methods, medical cost trend management, and forecasting. ... the public sector and commercial clients with specialized capabilities in strategy, technology, and risk management. You may not yet know our name, but we have a… more
    Guidehouse (07/02/20)
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  • Claims Manager Job

    BJ's Wholesale Club (Westborough, MA)
    …and benefits packages to help you succeed. Job Summary Reporting directly to the Director of Insurance and Risk Management the Claims Manager will lead the ... large insurance carrier with retail claims experience. + Strong foundation in claims adjustment and TPA management, litigation management and risk control as… more
    BJ's Wholesale Club (04/10/20)
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  • SVP Clinical Transformation Officer

    BayCare Health System (Clearwater, FL)
    …in population health including value based contracting, contract performance, population health analytics , risk adjustment , care gaps, utilization management ... measurement in partnership with patient care design, data warehousing and analytics . Supports and partners on implementation of culture changes for safety… more
    BayCare Health System (05/04/20)
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  • Advisor, Practice Performance Improvement

    Evolent Health (Detroit, MI)
    …implement interventions where applicable + Integrate care management, utilization management, risk adjustment , annual wellness visit and quality initiatives into ... Under the organization of the COO and with direction from the Director of Practice Performance Improvement, the Advisor is responsible for driving value-based… more
    Evolent Health (06/13/20)
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  • Associate Actuary - Northwest Division Finance

    Humana (Meridian, ID)
    …Development Advisor spanning Health Services (utilization review and care management), Medicare Risk Adjustment , Stars and quality, Provider Engagement and value ... and bid development for Medicare Advantage. This role will report to the Director of Finance and support Medicare operations across the Northwest Division, which… more
    Humana (06/12/20)
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