- 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
- Providence (Portland, OR)
- …work mostly remotely in the states of WA, OR and CA. **The Role:** As the Director of Risk Adjustment and Strategic Accounts at Providence Health Plan, you ... will be the cornerstone of our strategic vision. You will oversee risk adjustment programs, spearhead provider education, and enhance engagement to support… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …any legally protected characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Director of Risk Adjustment Location: Hybrid | Eagan, Minnesota ... Career Area: Special Services/Product Lines The Impact You Will Have The Director of Risk Adjustment is a key leader responsible for shaping risk … more
- Datavant (Augusta, ME)
- …for healthcare. **Role Overview** As the Director of Prospective + Concurrent Risk Adjustment Products, you will lead the strategy, roadmap, and execution ... on identifying and acting on undiagnosed conditions (prospective suspecting) and ensuring risk adjustment coding accuracy in near real-time (concurrent review).… more
- Centene Corporation (Austin, TX)
- …and management of department overseeing compliance with regulations and laws related to Risk Adjustment across our Marketplace, Medicaid and Medicare lines of ... assessments oversight and the monitoring work plans pertaining to Risk Adjustment . Partners with business areas to ensure and implement effective prevention,… more
- Highmark Health (Pittsburgh, PA)
- …to Quality and Coding for the Highmark Health Enterprise. Ensures that Highmark's Risk Adjustment programs comply with all applicable guidelines, regulations and ... Coding: Manage a team of internal coder / clinicians that perform Risk Adjustment coding of medical records. Track production coding results and monitor accuracy… more
- CareFirst (Baltimore, MD)
- … Analytics team is hiring a lead data analyst with deep experience in risk adjustment . This person will support the Director of Risk Adjustment by ... monitoring and reporting on risk adjustment KPIs, delivering insights for prospective and retrospective risk adjustment operational decisions, and… more
- Ankura (New York, NY)
- …operations, investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment . The Senior Director will also ... of activities: + Help clients manage proactive and reactive Medicare and Commercial Risk Adjustment compliance, audit, and investigation projects for clients. +… more
- Ankura (New York, NY)
- …college/university + Current Registered Nurse license + Experience working for payors conducting risk adjustment reviews + Clinical experience in a variety of ... and mature their compliance programs, conduct program effectiveness reviews, and risk assessments, and perform compliance audits. We assist in-house and outside… more
- Molina Healthcare (St. Petersburg, FL)
- …monitoring, and oversight of all chart collection for HEDIS, or HEDIS-like projects, Risk Adjustment , Risk Adjustment Data Validation, and ... **Job Description** **Job Summary** The Director , Clinical Data Acquisition is responsible for the...that support business objectives. + HEDIS Operations experience. + Risk Adjustment and Data Validation experience. +… more
- Datavant (Olympia, WA)
- …strategic mindset and a focus on continuous improvement. + Familiarity with CMS HCC risk adjustment processes preferred \#LI-BC1 We are committed to building a ... professional, educational and life experiences to realize our bold vision for healthcare. The Director of Client Success will report to the VP of Client Success and… 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 ... hardwiring processes to drive excellence in efficiency of care, quality and accurate risk adjustment for all populations served, especially our patients covered… more
- Henry Ford Health System (Troy, MI)
- …Cycle processes within value-based reimbursement models and initiatives. Reporting to the Director , Risk Adjustment and Value-Based Payment, the Program ... Manager is responsible for complex program management, strategic planning, and process improvement activities. The leader acts with a high degree of autonomy focusing on improving Revenue Cycle processes, Population Health program management, Accountable Care… more
- University of Utah Health (Murray, UT)
- …responsibility, integrity, quality and trust that are integral to our mission. EO/AA_ + Risk Adjustment Analyst position provides support for our health plan's ... risk adjustment program. + This role is...sexual misconduct including sexual harassment, you may contact the Director /Title IX Coordinator in the Office of Equal Opportunity… more
- Evolent (Helena, MT)
- …You'll Be Doing:** **Manager, Coding Support Specialist** Evolent Care Partners is seeking a Risk Adjustment Coding Support Manager to be a core member of the ... Risk Adjustment Coding Support team. Evolent Care...coding questions and issues. + Collaborate with the coding director to develop policies, procedures, and workflows to enhance… more
- Commonwealth Care Alliance (Boston, MA)
- … Director of Encounter Data Management within the Revenue Cycle Department, the Risk Adjustment Data Developer is responsible for the design, development, and ... of data systems and tools that support Commonwealth Care Alliance's (CCA) risk adjustment and Hierarchical Condition Category (HCC) revenue programs. This… more
- New York State Civil Service (Albany, NY)
- NY HELP No Agency Financial Services, Department of Title Financial Crimes Risk Manager ( Director Financial Services Programs 1, SG-31) Occupational Category ... of Financial Services is seeking candidates for the position of Financial Crime Risk Manager, ( Director Financial Services Programs 1), in Virtual Currency.… more
- University of Utah (Salt Lake City, UT)
- …**Open Date** 07/09/2025 **Requisition Number** PRN42423B **Job Title** Associate Director , Student Services **Working Title** Associate Director , Student ... Utah seeks a highly organized, motivated, and collaborative leader to serve as the Associate Director of Student Support ( ADSS ), As part of the Office of the Dean… more
- Elevance Health (Cincinnati, OH)
- …Capabilities and Experiences:** + Deep understanding of CMS-HCC and/or HHS-HCC risk adjustment methodologies strongly preferred. + Experience partnering with ... **Clinical Compliance Medical Director ** _Please note that per our policy t_...regulatory, compliance, and legal matters strongly preferred. + Certified Risk Adjustment Coder (CRC) or similar credential… more
- Point32Health (NH)
- …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