- Datavant (Lincoln, NE)
- …experiences to realize our bold vision for healthcare. **Role Overview** As a Product Manager , Risk Adjustment Analytics Products, you will contribute to the ... strategy and execution of analytics capabilities that power Datavant's risk adjustment solutions. You'll drive the development of robust, scalable, and… more
- Marshfield Clinic (Marshfield, WI)
- …a management or leadership role with working knowledge of CMS and/or Medicaid risk adjustment methodologies. **CERTIFICATIONS/LICENSES** _The following ... to support the most exciting missions in the world!** **Job Title:** Risk Adjustment Revenue Director (Remote/Hybrid) **Cost Center:** 682891390 SHP-Strategic… more
- Elevance Health (Louisville, KY)
- …for completing projects and performing complex actuarial studies related to risk adjustment analytics in both the Medicaid and Medicare Advantage lines of ... Analyzes and develops SAS and SQL programming to support Medicaid and Medicare Advantage risk adjustment...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Marshfield Clinic (Marshfield, WI)
- …exciting missions in the world!** **Job Title:** Director of Actuarial and Risk Adjustment Services **Cost Center:** 682891378 SHP-Actuarial **Scheduled Weekly ... **Job Description:** **JOB SUMMARY** The Director of Actuarial & Risk Adjustment Services is a key leader...participation in any federally funded program, including Medicare and Medicaid . This is a condition of employment. Employee must… more
- Deloitte (Tempe, AZ)
- …with Medicaid waivers (ie, 1115, 1915 b/c, 1332) + Experience with risk adjustment mechanisms + Experience with Provider reimbursement streams (ie, DSH, UPL, ... health plan/insurance company experience + 5+ years of experience with Medicaid managed care capitation rate development and/or fee-for-service rate development +… more
- Molina Healthcare (Madison, WI)
- …Manager , Provider Engagement establishes strategies and operational directions for risk adjustment and quality improvement. Collaborates with senior ... strategies. Sets and manages performance goals, ensuring providers meet quality and risk adjustment targets through coaching and consistent engagement. Tracks… more
- New York State Civil Service (Bronx, NY)
- NY HELP Yes Agency Mental Health, Office of Title Intensive Case Manager (NY HELPS), New York City Children's Center, Bronx Campus, P26040 Occupational Category ... Duties Description NYCCC is recruiting a Director of Clinical Risk Management Department to oversee their Risk ...- Statewide (NY HELPS) program as an Intensive Case Manager if they have:* Bachelor's degree in social work,… more
- Datavant (Providence, RI)
- …inpatient setting. + Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment , CDI, Medicaid , Commercial RA, and HEDIS experience. + ... vision for healthcare. As a Sr. Client Coding Project Manager , you will plan, forecast, and manage client-facing coding...clients understand the shifts and trends happening in the risk adjustment coding space. **What you will… more
- Henry Ford Health System (Troy, MI)
- …value-based reimbursement models and initiatives. Reporting to the Director, Risk Adjustment and Value-Based Payment, the Program Manager is responsible for ... The Program Manager - Population Health & Value-Based Payment has an...departmental staff and multi-disciplinary teams. + Knowledge of Medicare, Medicaid , Blue Cross and other third-party payers billing and… more
- MedKoder (Mandeville, LA)
- …company offers services including inpatient and outpatient facility coding, medical risk adjustment management, DRG coding management, coding education, clinical ... the direction of the Director of Physician Coding, the Audit and Education Manager is responsible for leading and maintaining the Auditing and Education team. This… more
- Tufts Medicine (Lowell, MA)
- …aligned with the Hospital Quality and Equity Incentive Program of the Massachusetts Medicaid 1115 Waiver. This work will spread across the Tufts Medicine Health ... Medical Officer for Quality, the Melrose Wakefield Hospital Senior Director Quality, Risk Management & Patient Safety and the Lowell General Hospital Vice President,… more
- Marshfield Clinic (Marshfield, WI)
- …internal and external stakeholders as it relates to Medicare Advantage, ACA/Exchange and Medicaid risk adjustment reimbursement methodologies and policies to ... ensure the accuracy and integrity of risk adjustment data submitted to the Centers... data submitted to the Centers for Medicare & Medicaid Services (CMS) and the Department of Health Services… more
- Cambridge Health Alliance (Cambridge, MA)
- …for overseeing Medicaid and Medicare enrollment, claims, reporting, risk adjustment , compliance, contract management, and system efficiency, while ... compliance with MassHealth renewals and Medicare risk adjustment documentation. * Oversee Medicare and Medicaid ...* Oversee Third Party Administrator (TPA) and Pharmacy Benefit Manager (PBM). * Monitor and manage claim processing and… more
- Hartford HealthCare (Farmington, CT)
- …and education specialist will support documentation practices that comply with CMS risk adjustment program requirements and ICD 10 coding guidelines. Reporting ... to Manager of Audit and Education *_Position Responsibilities:_* *Key Areas...6. Identify process improvements to capture data for Medicare Risk Adjustment and help providers code to… more
- CareOregon (Portland, OR)
- …and forecasting activities, actuarial analyses, accounting operations, financial reporting, risk adjustment and procurement functions. + Supports emerging ... accounting, financial reporting, financial planning, forecasting, actuarial analysis and risk adjustment + Expert understanding of financial structures,… more
- Convey Health Solutions (Chicago, IL)
- …knowledge to accelerate analytic insights and new feature enhancements to Pareto's risk adjustment solution suite. Additionally, the ability to understand / ... which contribute to new features. + Collaborate with the Manager , Data Analytics and Product team to support analytical...questions for empowering key stakeholders to gain insights into risk adjustment performance. + Provide data analysis… more
- CareOregon (Portland, OR)
- …Medicare bid development, rate setting optimization, forecasting support, benchmarking, risk adjustment optimization, provider payment evaluation and review ... purposes of assessing our performance and the potential for improvement. | Monitor risk adjustment applied to capitation revenue and ensure population risk… more
- CareOregon (Portland, OR)
- …Medicare bid development, rate setting optimization, forecasting support, benchmarking, risk adjustment optimization, provider payment evaluation and review ... Exemption Status Exempt Management Level n/a Direct Reports n/a Manager Title Actuarial Services Manager Department Finance...our performance and the potential for improvement. + Monitor risk adjustment applied to capitation revenue and… more
- CareOregon (Portland, OR)
- …Experience in Medicaid , quality assurance, utilization review, case management, and/or risk adjustment + Experience with CareOregon or other CCO operations ... Level Director Direct Reports Sr Planning & Operations Specialist, Network Support Manager Manager Title Vice President, CareOregon Metro Department CareOregon… more
- Actalent (Sunrise, FL)
- …mental illness (SMI). Responsibilities + Lead a multidisciplinary team to identify high- risk clients, address care gaps, and collaborate with providers to enhance ... admissions and placements. + Conduct thorough needs assessments, including risk stratification, to determine health, psychological, educational, and social needs.… more