- Point32Health (Canton, MA)
- …and business division goals. This position will report to the Director of Risk Adjustment Strategy , Operations and Quality Assurance. **Job Description** ... will oversee all provider engagement and reporting activities for risk adjustment programs and initiatives that impact Medicare , Medicaid, and Duals product… more
- Ankura (New York, NY)
- …master's degree from an accredited college/university + 8+ years of experience in Medicare Risk Adjustment operations, internal audit, or compliance either ... compliance, accreditations, operations, investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment . The… more
- Elevance Health (West Des Moines, IA)
- …for completing projects and performing complex actuarial studies related to risk adjustment analytics in both the Medicaid and Medicare Advantage lines of ... develops SAS and SQL programming to support Medicaid and Medicare Advantage risk adjustment initiatives....creating a culture that is designed to advance our strategy but will also lead to personal and professional… more
- CareFirst (Baltimore, MD)
- … Manager plays a critical role in the development and execution of the corporate risk adjustment strategy . The role serves as a dedicated resource within ... the organization for Medicare Advantage, Medicaid and ACA markets, coordinating and leading... strategy by applying improvements and driving cost-effective risk adjustment actions across all organizational populations… more
- CareFirst (Baltimore, MD)
- …risks or barriers to leadership to ensure that all risk adjustment activities fully comply with Medicare , Medicaid, ACA, and state-specific regulations. ... **Resp & Qualifications** **PURPOSE:** The Risk Adjustment Coding Operations Supervisor supports...Operations Supervisor supports the execution of the corporate coding strategy across Medicare Advantage, Medicaid, and ACA… more
- Health Care Service Corporation (Chicago, IL)
- …key performance indicators, trends, and financial acumen + Knowledge of Medicare Stars, Medicare Risk Adjustment , and Medicare Finance. + Strong ... leading the team to support divisional short and long-term initiatives related to Medicare provider network strategy and leverage analytics to drive provider… more
- Centene Corporation (Harrisburg, PA)
- …related experience including quality improvement, HEDIS operations, and Risk Adjustment . Experience with quality rating systems, Medicare products, ... Oversee aspects of the company quality measure improvement outreach strategy including the execution of function for all markets...best practices towards achieving market and product quality and risk goals + Serve as subject matter expert in… 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 ... years in Medicare Advantage, Medicaid managed care, or healthcare product strategy . + Preferred: 5 years of experience with D-SNPs or dual-eligible populations.… more
- Convey Health Solutions (Fort Lauderdale, FL)
- …+ Lead Product Strategy : Define and execute the roadmap for the Medicare Advantage Risk Adjustment solution, ensuring alignment with company goals ... a highly skilled and results-driven Senior Product Manager to lead our Medicare Advantage Risk Adjustment solution portfolio. In this critical role, you will… more
- Molina Healthcare (San Diego, CA)
- …+ Establishes strategy and operational direction for engaging providers on risk adjustment & quality improvement in collaboration with the Plan President, ... Practice Transformation resources. + Collaborates with Health Plan Network to drive value-based care strategy related to risk adjustment & quality. + Sets… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …and vendor performance relative to established contracts. * Collaborate with actuarial, finance, Medicare and risk adjustment to ensure all inputs and ... to support Medicare network reviews. Inform the Medicare VBC strategy by projecting Medicare...Works closely with actuarial, finance, data & analytics, stars, risk adjustment , and other lever owners to… more
- Molina Healthcare (Iowa City, IA)
- …Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Drives provider ... place and carried out to meet annual quality & risk adjustment performance goals.** **Job Duties** +...Healthcare. + 1 year of experience in Medicaid and/or Medicare managed care To all current Molina employees: If… more
- ChenMed (Miami, FL)
- …+ Comprehensive knowledge of Medicare program including but not limited to Risk Adjustment processes and Fee For Service. + Knowledge of applicable federal, ... Revenue Cycle Management (RCM) Optimization manages and organizes revenue strategy activities to maximize cash flow through the creation...incumbent also serves as a subject matter expert on risk - adjustment and medical economics to aid in… more
- Point32Health (NH)
- …and will work in a matrix environment collaborating with functions including risk adjustment , population health, finance, operations, actuarial, and sales. **Job ... **Job Summary** The Director of Contracting is responsible for contract strategy , development, negotiation, and implementation for hospitals, physician groups, and… more
- Humana (Sacramento, CA)
- …+ Experience working with physician groups, provider contracting, market operations, and Medicare Risk Adjustment and Stars/Quality functions + Knowledge ... and oversight of the annual budget, financial planning and projections, risk management and operational metrics and reporting while working with value-based… more
- Humana (Atlanta, GA)
- …assigned provider. The Senior Coding Educator is responsible for creating and executing the risk adjustment strategy for each provider groups. + Analyzes ... with relationship owners and HQRI + Monitors and develops strategy with leader and Relationship Owner, tailor's provider group...Coder (CRC) + Experience interacting with healthcare providers + Medicare Risk Adjustment knowledge +… more
- Humana (Washington, DC)
- …in a health care and / or Insurance setting + Working knowledge of Medicare Risk Adjustment and/or Stars + Experience utilizing Articulate products ... solutions are necessary or relevant. Begins to influence department's strategy . Makes decisions on moderately complex to complex issues...Information** This role will be responsible for supporting the Medicare Risk Adjustment Team within… more
- Humana (Olympia, WA)
- …nursing (BSN), or a related field, or equivalent work experience. + Experience with Medicare Risk Adjustment and/or medical coding. + Experience with ... advance their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies. Recommend execution strategies and monitor… more
- Deloitte (Colorado Springs, CO)
- …care and fee-for-service, Medicaid policy, budget forecasting and fiscal analyses, and risk adjustment + Support business development efforts for Federal and ... develop, and motivate my workforce? What should my AI strategy be for the HR function? Do I have...waivers (ie, 1115, 1915 b/c, 1332) + Experience with risk adjustment mechanisms + Experience with Provider… more
- Molina Healthcare (WA)
- …with setting annual targets for each VBP/VBC in conjunction with national quality and risk adjustment VPs, Regional Directors of Quality/ Risk , Director of ... revenue management, strategy , and compliance + Knowledge of value based programs, risk adjustment models, quality metrics such as HEDIS and STARS, knowledge… more