- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- … Adjustment Strategy Program Manager will report to the Senior Director of Medicare Risk Adjustment and Analytics. This role will manage the process ... changes, market dynamic forces, and new competitive threats around Medicare revenue and risk adjustment Assess new proposals or regulatory positions… more
- St. Luke's University Health Network (Quakertown, PA)
- …RN care managers, assistants, coordinators, utilization management staff, and director . Facilitates communication among all treatment team members. Manages length ... patient as healthy as possible in the outpatient setting, minimizing the risk of readmissions. Issues applicable state/federal regulatory notices as applicable ie.)… more
- Everlywell (Austin, TX)
- …with a strong understanding of HIPAA, CMS regulations, value-based care models, risk adjustment , and population health management strategies specific to ... products designed for health plan customers and their members. Reporting to a Director of Product Management , this role will lead initiatives to increase patient… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- … Adjustment Strategy Program Manager will report to the Senior Director of Medicare Risk Adjustment and Analytics. This role will manage the process ... regulatory changes, market dynamic forces, and new competitive threats around Medicare revenue and risk adjustment + Assess new proposals or regulatory… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …Bring your true colors to blue. Under the direction of the Senior Director of Medicare Risk Adjustment and Analytics, the Associate Director of ... Medicare and Merged Market segments. The Associate Director of Risk Adjustment Data...is responsible for the strategy, execution and performance of Medicare risk adjustment reporting and… more
- Marshfield Clinic (Marshfield, WI)
- …together to support the most exciting missions in the world!** **Job Title:** Risk Adjustment Revenue Director (Remote/Hybrid) **Cost Center:** 682891390 ... (United States of America) **Job Description:** **JOB SUMMARY** The Risk Adjustment Revenue Director is...strategy and related revenue management for Sanford Health Plan's Medicare , Affordable Care Act and Medicaid business and reports… more
- Blue KC (Kansas City, MO)
- …with adoption financial assistance** **Employee discount program** **Job Description Summary:** The Director , Government Programs Risk Adjustment & Audit ... and quality coding. + Provide Government Programs oversight to ensure Medicare Advantage and ACA Risk Adjustment and state regulations are maintained. +… more
- CareFirst (Baltimore, MD)
- …the organization within Medicare Advantage, Medicaid & ACA markets. The Risk Adjustment Director is responsible for strategic direction, leadership, ... **Resp & Qualifications** **PURPOSE:** The Director , Risk Adjustment oversees the outcomes and operations of risk adjustment across… more
- Corewell Health (Grand Rapids, MI)
- Job Summary The Director Risk Adjustment Prospective Operations & Risk Mitigation is the thought leader role responsible for ensuring the complete and ... role is a key strategic leader who initiates, develops and executes/implements the multi-product risk adjustment strategy set by the executive leaders of Risk… more
- Marshfield Clinic (Marshfield, WI)
- …come together to support the most exciting missions in the world!** **Job Title:** Director of Actuarial and Risk Adjustment Services **Cost Center:** ... (United States of America) **Job Description:** **JOB SUMMARY** The Director of Actuarial & Risk Adjustment...excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment.… more
- Centene Corporation (Austin, TX)
- …department overseeing compliance with regulations and laws related to Risk Adjustment across our Marketplace, Medicaid and Medicare lines of business, which ... assessments oversight and the monitoring work plans pertaining to Risk Adjustment . Partners with business areas to ensure and implement effective prevention,… more
- Commonwealth Care Alliance (Boston, MA)
- …skills in SQL, data integration, and systems development are essential. Knowledge of Medicare risk adjustment methodologies is highly desirable. The ideal ... adjustment data ecosystem. + Support audit readiness and regulatory compliance for Medicare and Medicaid risk adjustment programs. + Represent the … more
- Tufts Medicine (Burlington, MA)
- …as other technical requirements. 4. Summarizes and interprets audit findings for Director Risk Adjustment Operations/NEQCA Leadership; tracks audit results ... over time, identifies trends, and recommends corrective actions. 5. Collaborates with Director Risk Adjustment Operations/NEQCA staff and vendors to identify… more
- CVS Health (Boston, MA)
- …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
- Centene Corporation (Queens, NY)
- …+ Develop and refine Medicare contract models to incorporate RAF ( Risk Adjustment Factor) trends, Stars quality metrics, and benchmarking methodologies to ... execution of the organization's Value-Based Payment strategies (VBP) and other risk -based contracting strategies. + Oversee Medicare -specific VBP contracts,… 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
- Cambridge Health Alliance (Cambridge, MA)
- …and long-term care transitions. * Ensure regulatory compliance with MassHealth renewals and Medicare risk adjustment documentation. * Oversee Medicare ... Director , Health Plan Operations - PACE Elder Service...participants. This role is responsible for overseeing Medicaid and Medicare enrollment, claims, reporting, risk adjustment… more
- Mount Sinai Health System (New York, NY)
- …adjustment with a group of practices and (2) close partnership with the CDQI Director to drive accurate risk adjustment throughout the system. This ... the status quo **Role Summary:** MSHP seeks a Medical Director (MD), Physician Engagement and CDQI, who will (1)...drive excellence in efficiency of care, quality and accurate risk adjustment for all populations served, especially… more
- WelbeHealth (Los Angeles, CA)
- …Python, R), Excel, and financial modeling tools + Deep understanding of CMS risk adjustment , Medicaid rate-setting, and Medicare Advantage/Part D payment ... and financial analysis. This role will focus on overseeing capitation rates, risk adjustment methodologies, claims forecasting, and Incurred But Not Reported… more
- Point32Health (Canton, MA)
- …and will work in a matrix environment collaborating with functions including risk adjustment , population health, finance, operations, actuarial, and sales. **Job ... we are at Point32Health (https://www.point32health.org/) . **Job Summary** The Director of Contracting is responsible for contract strategy, development,… more
