- Mount Sinai Hospital (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 ... the status quo Role Summary: MSHP seeks a Medical Director (MD), Physician Engagement and CDQI, who will (1)...drive excellence in efficiency of care, quality and accurate risk adjustment for all populations served, especially… more
- Sante Health (Fresno, CA)
- …The Director will oversee and drive quality improvement initiatives, enhance Medicare Risk Adjustment and HEDIS measure performance, and support ... POSITION. A challenging and rewarding opportunity awaits a new Director of Quality Management at Sante Health System in...participation in programs. Initiate programs and process to increase Medicare Advantage Risk Adjustment Factor… more
- Molina Healthcare (Long Beach, CA)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... director , and quality improvement staff. Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. Reviews quality referred issues,… more
- UnitedHealth Group (Columbus, OH)
- …models Familiarity with Medicare Advantage, SNP regulations, and risk adjustment methodologies Excellent communication, presentation, and strategic thinking ... Group family of businesses, is seeking a Market Medical Director (MMD) to lead clinical strategy and quality initiatives...Market Leadership Team, working closely with the Market Executive Director and Director of Clinical Operations. The… more
- Medica (Hopkins, MN)
- …financial performance to Medica and segment leadership Incorporates the impact of risk adjustment into financial projections and performance analysis Provide ... technical knowledge and business acumen to analyze financial experience, quantify financial risk , and project future medical expenses. They are expected to adhere to… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- … Adjustment Strategy Program Manager will report to the Senior Director of Medicare Risk Adjustment and Analytics. This role will manage the process ... regulatory changes, market dynamic forces, and new competitive threats around Medicare revenue and risk adjustment + Assess new proposals or regulatory… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …Bring your true colors to blue. Under the direction of the Senior Director of Medicare Risk Adjustment and Analytics, the Associate Director of ... Medicare and Merged Market segments. The Associate Director of Risk Adjustment Data...is responsible for the strategy, execution and performance of Medicare risk adjustment reporting and… more
- Blue KC (Kansas City, MO)
- …with adoption financial assistance** **Employee discount program** **Job Description Summary:** The Director , Government Programs Risk Adjustment & Audit ... and quality coding. + Provide Government Programs oversight to ensure Medicare Advantage and ACA Risk Adjustment and state regulations are maintained. +… more
- CareFirst (Baltimore, MD)
- …the organization within Medicare Advantage, Medicaid & ACA markets. The Risk Adjustment Director is responsible for strategic direction, leadership, ... **Resp & Qualifications** **PURPOSE:** The Director , Risk Adjustment oversees the outcomes and operations of risk adjustment across… 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 ... 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
- Marshfield Clinic (Marshfield, WI)
- …come together to support the most exciting missions in the world!** **Job Title:** Director of Actuarial and Risk Adjustment Services **Cost Center:** ... (United States of America) **Job Description:** **JOB SUMMARY** The Director of Actuarial & Risk Adjustment...excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment.… more
- Centene Corporation (Austin, TX)
- …department overseeing compliance with regulations and laws related to Risk Adjustment across our Marketplace, Medicaid and Medicare lines of business, which ... assessments oversight and the monitoring work plans pertaining to Risk Adjustment . Partners with business areas to ensure and implement effective prevention,… more
- Commonwealth Care Alliance (Boston, MA)
- …skills in SQL, data integration, and systems development are essential. Knowledge of Medicare risk adjustment methodologies is highly desirable. The ideal ... adjustment data ecosystem. + Support audit readiness and regulatory compliance for Medicare and Medicaid risk adjustment programs. + Represent the … more
- Tufts Medicine (Burlington, MA)
- …as other technical requirements. 4. Summarizes and interprets audit findings for Director Risk Adjustment Operations/NEQCA Leadership; tracks audit results ... over time, identifies trends, and recommends corrective actions. 5. Collaborates with Director Risk Adjustment Operations/NEQCA staff and vendors to identify… more
- CVS Health (Boston, MA)
- …regulatory compliance. + Serve as a subject matter expert on CMS regulations, risk adjustment , and revenue optimization. + Collaborate with internal stakeholders ... CMS Part C/D operations. + 5+ years' experience working with CMS regulations, risk adjustment methodologies, and revenue management. + 5+ years' experience… more
- Centene Corporation (Queens, NY)
- …+ Develop and refine Medicare contract models to incorporate RAF ( Risk Adjustment Factor) trends, Stars quality metrics, and benchmarking methodologies to ... execution of the organization's Value-Based Payment strategies (VBP) and other risk -based contracting strategies. + Oversee Medicare -specific VBP contracts,… more
- Centene Corporation (Providence, RI)
- … Medicare contract models, incorporating CMS and NYSDOH guidelines related to risk adjustment , quality metrics, and financial benchmarks. + Collaborate with ... with Contract management and Service Fund teams to implement monitoring of Medicare -specific VBP contracts, including models with upside/downside risk , shared… more
- Cambridge Health Alliance (Cambridge, MA)
- …and long-term care transitions. * Ensure regulatory compliance with MassHealth renewals and Medicare risk adjustment documentation. * Oversee Medicare ... Director , Health Plan Operations - PACE Elder Service...participants. This role is responsible for overseeing Medicaid and Medicare enrollment, claims, reporting, risk adjustment… 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 ... the status quo **Role Summary:** MSHP seeks a Medical Director (MD), Physician Engagement and CDQI, who will (1)...drive excellence in efficiency of care, quality and accurate risk adjustment for all populations served, especially… more
- WelbeHealth (Los Angeles, CA)
- …Python, R), Excel, and financial modeling tools + Deep understanding of CMS risk adjustment , Medicaid rate-setting, and Medicare Advantage/Part D payment ... and financial analysis. This role will focus on overseeing capitation rates, risk adjustment methodologies, claims forecasting, and Incurred But Not Reported… more
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