- Highmark Health (Pittsburgh, PA)
- …Quality and Coding for the Highmark Health Enterprise. Ensures that Highmark's Risk Adjustment programs comply with all applicable guidelines, regulations and ... + Production Coding: Manage a team of internal coder / clinicians that perform Risk Adjustment coding of medical records. Track production coding results 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
- 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 ... Special Services/Product Lines The Impact You Will Have The Director of Risk Adjustment is...impact analysis, pricing guidance, and budget recommendations. * Leads Quality and Risk Adjustment analytic… 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 ... quality and overall impact of the company's risk adjustment program, including reporting KPIs on...collaboration cross all relevant internal departments/positions that intersect with risk adjustment ( Quality , Provider Relations,… 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
- 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 ... experiences to realize our bold vision for healthcare. The Director of Client Success will report to the VP...updates, etc.). + Identify project risks that impact the quality of our product and services delivery to 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
- University of Utah Health (Murray, UT)
- …utilization, cost structure, and/or quality . + Demonstrated knowledge with the specific risk adjustment models. HHS HCC, CMS HCC and MARA. + Demonstrated ... to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission....trust that are integral to our mission. EO/AA_ + Risk Adjustment Analyst position provides support for… 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...progress note clinical documentation review. + Ensure compliance and quality for all coding practices maintaining high standards and… 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
- CareFirst (Baltimore, MD)
- …make informed decisions and assist the organization in making better business decisions. The Quality , Stars, and Risk Adjustment 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 … more
- Bristol Myers Squibb (Devens, MA)
- …supply chain throughout the product lifecycle . He/She m anage s product quality risk throughout the product lifecycle, including oversight of process and ... their personal lives. Read more: careers.bms.com/working-with-us . **Position Summary** The Senior Director , Cell Therapy Global Product Quality Lead ( Sr. Dir.… more
- Mount Sinai Health System (New York, NY)
- …CDQI, who will (1) be responsible for driving key population health goals including access, quality , utilization and accurate risk adjustment with a group of ... practices and (2) close partnership with the CDQI Director to drive accurate risk adjustment...hardwiring processes to drive excellence in efficiency of care, quality and accurate risk adjustment … 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
- Point32Health (NH)
- …and will work in a matrix environment collaborating with functions including risk adjustment , population health, finance, operations, actuarial, and sales. **Job ... to enable high performing provider networks that support goals for membership growth, quality , and financial performance. The Director will foster and maintain… more
- Bristol Myers Squibb (New Brunswick, NJ)
- …improvement. * Cultivate and sustain strategic partnerships with External Engagement, Quality Risk Management and Operations & Performance to identify, ... lives. Read more: careers.bms.com/working-with-us . **Position Summary** Reporting to the Director , Inspection Readiness, the Associate Director will help drive… more
- Bristol Myers Squibb (New Brunswick, NJ)
- …provide together with the Associate Director Risk Management and Director Quality Risk Management strategic and tactical oversight. This position ... capabilities and QRM process elements in partnership with the Director Quality Risk Management. +...in their roles. Applicants can request a reasonable workplace accommodation/ adjustment prior to accepting a job offer. If you… more
- Centene Corporation (Nashville, TN)
- …**Remote Opportunity** **Ideal candidate will have background in HEDIS Operations and Risk Adjustment with experience in clinical data analysis, claim and ... and streamlined workflow. + Responsible for National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information… more
- Scripps Health (San Diego, CA)
- …Categories (HCCs) for accuracy and compliance as relates to Outpatient CDI. Monitors Risk Adjustment Factor (RAF) Scores. * Directs instructions and education ... This Senior Director position is eligible to participate in the...career. * Our specialties have been nationally recognized for quality in areas such as cardiovascular care, oncology, orthopedics,… more