- Kaiser Permanente (Oakland, CA)
- …to lead the planning, execution, and oversight of strategic initiatives that support prospective Medicare risk adjustment efforts. This pivotal role will be ... Overview: The Prospective Risk Adjustment Operations team is seeking a Program...Employee Job Level: Individual Contributor Department: Po/Ho Corp - Medicare LOB Admin - 0308 Pay Range: $101200 -… more
- Blue Cross and Blue Shield of Minnesota (St. Paul, MN)
- …provider and vendor performance relative to established contracts. Collaborate with actuarial, finance, Medicare and risk adjustment to ensure all inputs and ... Have We are looking for an Actuary for our Medicare Provider Relations team! You will apply broad actuarial...Works closely with actuarial, finance, data & analytics, stars, risk adjustment , and other lever owners to… more
- Advantmed (Portland, OR)
- …provider network. In this role, you will be responsible for conducting in-home wellness risk adjustment assessments for Medicare members and other at ... About Advantmed Advantmed is a leading provider of risk adjustment , quality improvement and value-based...drive market leading performance with integrated technology, service, and program solutions that optimize the risk and… more
- Iconma LLC (Lansing, MI)
- … Risk Adjustment Program Knowledge: Understanding of relevant risk adjustment programs, such as Medicare Advantage, and their specific ... their Lansing, MI location. Responsibilities: This engagement requires a highly skilled Risk Adjustment Business Analyst who can bridge regulatory requirements… more
- AdventHealth (Altamonte Springs, FL)
- …out-of-pocket tuition expense) *For eligible positions* Nursing Clinical Ladder Program *For eligible positions* Whole Person Well-being and Mental Health Resources ... social determinants of health into transitions of care planning and applies risk mitigation interventions to meet the individual needs of each patient Identifies… more
- AdventHealth (Hinsdale, IL)
- …Time Off from Day One for FT/PT positions *Student Loan Repayment Program for FT/PT positions *Career Development *Whole Person Wellbeing Resources *Mental Health ... coordinates and facilitates the development of a discharge plan of care for high- risk patient populations. This role will receive referrals for individuals from at-… more
- Molina Healthcare (Long Beach, CA)
- …plan products to coordinate a medical plan of care and capture diagnoses for Medicare risk adjustment . The NP/PA will utilize advanced assessment skills ... a physical examination. Capture and document annual diagnoses accurately consistent with Medicare risk adjustment . Conduct comprehensive annual medication… more
- Healthcare in Action (Los Angeles, CA)
- …experiencing homelessness through an innovative "street medicine" approach by contracting with Medicare and Medicaid health plans as well as hospitals and health ... and parks. The Nurse (RN) supports members who are experiencing or are at risk of experiencing homelessness, managing their own health by providing direct care as a… more
- UnitedHealth Group (Columbus, OH)
- …models Familiarity with Medicare Advantage, SNP regulations, and risk adjustment methodologies Excellent communication, presentation, and strategic thinking ... consultation, and drives quality and affordability initiatives across the Optum at Home program . This position is supporting the OH and MI market, but you can… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …to help us transform healthcare? Bring your true colors to blue. The Medicare Risk Adjustment Strategy Program Manager will report to the Senior Director ... of Medicare Risk Adjustment and Analytics....of Medicare Risk Adjustment and Analytics. This role will...program results, and represent and advocate for the Risk Adjustment Team's business interests in corporate… more
- Elevance Health (Woodbridge, NJ)
- ** Medicare Risk Adjustment Advanced Analytics Analyst** **On-Site Requirement: Hybrid 1;** **This role requires associates to be in-office 1 - 2 days per ... an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Advanced Analytics...Performs data mining and data-driven analyses to evaluate historical program performance and to inform current operating decisions. +… more
- Elevance Health (Louisville, KY)
- ** Medicare Risk Adjustment Advanced...and internal partners to apply the insights to drive risk adjustment program innovation and ... an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Advanced Analytics...the right members for the right service, to measure program outcomes, and to support information-based strategic decision making.… more
- UCLA Health (Los Angeles, CA)
- Description As the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment , you will be an expert in risk adjustment coding ... and documentation, working closely with physicians, IPA coders, and risk adjustment teams associated with the health...(II), and HCPCS coding systems required + Knowledge of Medicare Advantage STARS/HEDIS program and NCQA technical… more
- Blue KC (Kansas City, MO)
- …and technical teams to develop the tools, processes, and reporting required to ensure a compliant risk adjustment program . + Build and maintain the risk ... **Employee discount program ** **Job Description Summary:** The Director, Government Programs Risk Adjustment & Audit assumes overall leadership of the … more
- Trinity Health (Albany, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** ** Risk Adjustment Auditor Educator** -St. Peter's Health Partners - Full-time - Remote ... **POSITION PURPOSE:** A Risk Adjustment Auditor Educator is responsible for...value-based plans (VBP), Medicare Advantage (MA) and Medicare shared savings program (MSSP) as well… more
- Trinity Health (Syracuse, NY)
- …to conduct Education if needed. Auditing Experience Posting **POSITION PURPOSE:** A Risk Adjustment Auditor Educator is responsible for ensuring accurate coding ... and documentation in alignment with risk adjustment models, conducting audits with analysis...value-based plans (VBP), Medicare Advantage (MA) and Medicare shared savings program (MSSP) as well… more
- Highmark Health (Blue Bell, PA)
- …Develop, oversee and adapt infrastructure (processes, systems, talent) to support an effective risk adjustment program as CMS/HHS/DPW evolves the models and ... for risk revenue management for all government program products (commercial ACA, Medicare , and Medicaid)....direct management experience Preferred: + 5 or more years' Medicare and/or Commercial risk adjustment … more
- Marshfield Clinic (Marshfield, WI)
- …to support the most exciting missions in the world!** **Job Title:** Risk Adjustment Revenue Director (Remote/Hybrid) **Cost Center:** 682891390 SHP-Strategic ... (United States of America) **Job Description:** **JOB SUMMARY** The Risk Adjustment Revenue Director is a finance...or be excluded from participation in any federally funded program , including Medicare and Medicaid. This is… more
- Molina Healthcare (Roswell, NM)
- …Health Plan strategic analysis and planning and coordinates across business units on Risk Adjustment Program Valuation and Strategic/Scoreable Action Items ... analytic / programming tools as needed + Reporting includes Risk Adjustment program performance metrics,...risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA… more
- Corewell Health (Grand Rapids, MI)
- …achieving related revenue targets.The role is responsible for helping to achieve the risk adjustment program vision, strategies, objectives, and goals. This ... performance indicators (KPIs) measure productivity, quality and overall impact of the company's risk adjustment program , including reporting KPIs on a… more
