- Ankura (New York, NY)
- …investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment . The Senior Director will also support ... master's degree from an accredited college/university + 8+ years of experience in Medicare Risk Adjustment operations, internal audit, or compliance either… more
- Point32Health (Canton, MA)
- …with our corporate and business division goals. This position will report to the Director of Risk Adjustment Strategy, Operations and Quality Assurance. ... will oversee all provider engagement and reporting activities for risk adjustment programs and initiatives that impact Medicare , Medicaid, and Duals product… more
- Catholic Health Initiatives (Little Rock, AR)
- …for the value hub. + Through Risk Management/Auditor Manager, implements a risk adjustment coding department in appropriate Arkansas and Kentucky CIN. + ... Extensive CIN/Population Health Management experience required + Must have experience with risk adjustment coding and value based reimbursement models of payment… 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
- 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
- CenterWell (Jacksonville, FL)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... and help us put health first** The Associate Medical Director (AMD) is an instrumental clinical leader of our...coaching initiatives are precise + Identify critical issues for high- risk patients during case reviews & other forums, and… more
- CenterWell (Kansas City, KS)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... and help us put health first** The Associate Medical Director (AMD) is an instrumental clinical leader of our...coaching initiatives are precise. + Identify critical issues for high- risk patients during case reviews & other forums, and… more
- CenterWell (Daytona Beach, FL)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... and help us put health first** The Associate Medical Director (AMD) is an instrumental clinical leader of our...and coaching initiatives are precise *Identify critical issues for high- risk patients during case reviews & other forums, and… more
- CenterWell (Columbia, SC)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... and help us put health first** The Associate Medical Director (AMD) is an instrumental clinical leader of our...coaching initiatives are precise + Identify critical issues for high- risk patients during case reviews & other forums, and… more
- Dignity Health (Bakersfield, CA)
- …and dual eligible populations, and benefit systems is preferred. - HEDIS/Stars and HCC/ Risk adjustment knowledge. \#LI-DH **Where You'll Work** The purpose of ... primarily in the Bakersfield/Central CA region.** **Position Summary:** The Medical Director of Physician Engagement is responsible for developing and driving… more
- CVS Health (Tallahassee, FL)
- …treatment protocols for DSNP/MMP and other complex health populations to optimize risk adjustment , clinical quality, and care management. * Actively participate ... oversight of DSNP/MMP complex populations (Dual-Eligible Special Needs Plan / Medicare -Medicaid Plan) * Develop and lead clinical strategy and objectives for… more
- Hartford HealthCare (Farmington, CT)
- …observed to expected ratio (O:E), capture of appropriate severity of illness (SOI) and risk of mortality (ROM), risk adjustment and hierarchal condition ... capture (HCC) codes, risk adjustment , and other high quality documentation outcome measures. ....Evaluation and 1:1 discussions under the direction of CDI Manager/ Director . . Provides CDI subject matter expert guidance to… more
- St. Luke's University Health Network (Quakertown, PA)
- …to: RN care managers, assistants, coordinators, utilization management staff, and director . . Facilitates communication among all treatment team members. . Manages ... patient as healthy as possible in the outpatient setting, minimizing the risk of readmissions. . Issues applicable state/federal regulatory notices as applicable… more
- St. Luke's University Health Network (Sellersville, PA)
- …to: RN care managers, assistants, coordinators, utilization management staff, and director . + Facilitates communication among all treatment team members. + Manages ... patient as healthy as possible in the outpatient setting, minimizing the risk of readmissions. + Issues applicable state/federal regulatory notices as applicable… more
- Emanate Health (Covina, CA)
- …MSO personnel on HCC and STAR measures related tasks. Responsible to ensure the IPA risk adjustment factor maintains or exceeds 1.0 and achieves or improves upon ... ensure the appropriate ICD10 and CPT codes submitted for Medicare and Covered CA lines of business. Coding specialist...Must have at least one year of experience in Medicare HCC program within IPA, HMO, or clinic setting.… more
- Point32Health (Canton, MA)
- …for key initiatives + Serve as the key liaison for Actuarial, Finance, Risk Adjustment , Corporate Data and Analytics, Medical Cost Management, and Pharmacy ... improvement recommendations based on analytic findings. Under the direction of the Director of Product Strategy, the Manager contributes to building presentations of… more
- Fair Haven Community Health Care (New Haven, CT)
- …data (Medicaid/ Medicare /commercial). + Working knowledge of eCQMs, UDS, HEDIS, risk adjustment /HCCs, and value-based care measures. + Ability to translate ... Haven Community Health Care (FHCHC). Duties and responsibilities Reporting to the Director of Data, the Senior Data Analyst will effectively prioritize and execute… more