- Molina Healthcare (Long Beach, CA)
- …medical plan of care and capture diagnoses for Medicare risk adjustment . The NP/PA will utilize advanced assessment skills to diagnose and manage chronic ... a physical examination. Capture and document annual diagnoses accurately consistent with Medicare risk adjustment . Conduct comprehensive annual medication… 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 solutions to health plans and providers. We drive market… more
- AdventHealth (Hinsdale, IL)
- …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- ... risk populations from interdisciplinary team members (including physicians, RN...substance use and addictive disorders o Provides patient/family education, adjustment -to-illness counseling, grief counseling and crisis intervention o Provides… more
- UnitedHealth Group (Columbus, OH)
- …models Familiarity with Medicare Advantage, SNP regulations, and risk adjustment methodologies Excellent communication, presentation, and strategic thinking ... outcomes and reduce avoidable utilization Provide clinical consultation and support to advanced practice clinicians (APCs) and care teams Serve as a subject matter… more
- Hueman Risk Adjustment Solutions (Southwest Harbor, ME)
- …is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and ... BLS certification 12 months of experience as a paid advanced clinical provider is preferred but not required To...should be a fundamental part of every role in risk assessment. Our opportunities provide flexibility, extra income, and… 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 ... for employment, unless an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Advanced Analytics Analyst** is responsible for… more
- Elevance Health (Louisville, KY)
- ** Medicare Risk Adjustment Advanced Analytics Consultant** **On-Site Requirement: Hybrid 1;** **This role requires associates to be in-office 1 - 2 days ... for employment, unless an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Advanced Analytics Consultant** is responsible for… 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
- Blue KC (Kansas City, MO)
- …clinical documentation and quality coding. + Provide Government Programs oversight to ensure Medicare Advantage and ACA Risk Adjustment and state ... + Maintain expert knowledge of ACA risk adjustment regulations + Maintain expert knowledge of Medicare...one and obtain both certifications, CRC and CPC. + Advanced knowledge of ICD10-CM coding. + Proficiency in MS… more
- Highmark Health (Blue Bell, PA)
- …At least five years' direct management experience Preferred: + 5 or more years' Medicare and/or Commercial risk adjustment experience + Previous involvement ... Development and Management: + Provide strategic leadership and management for the Risk Adjustment Accuracy Management Department. + Develop and oversee programs… more
- Tufts Medicine (Burlington, MA)
- …the greater Boston region. **Job Overview** Under the director of the Director, Risk Adjustment Operations, performs accurate and timely reviews and validations ... of Medicare , Medicaid, Commercial HCCs and DxCG's through medical record...established coding standards as well as CMS and Commercial Risk Adjustment guidelines. This position has extensive… more
- Molina Healthcare (Roswell, NM)
- …role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling ... complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data to evaluate healthcare...risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA… more
- Datavant (Lincoln, NE)
- …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 actionable analytics… 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
- Hartford HealthCare (Hartford, CT)
- …in a variety of settings 3. Identify process improvements to capture data for Medicare Risk Adjustment 4. Builds relationships, programs, and processes ... recognition programs and other common practices across the system. *JOB SUMMARY:* The Risk Adjustment Coder Educator develops and implements an enterprise-wide … more
- Molina Healthcare (Janesville, WI)
- …medical plan of care and capture diagnoses for Medicare risk adjustment . The NP/PA will utilize advanced assessment skills to diagnose and manage chronic ... member health outcomes. The NP/PA is responsible for completing advanced practice consultations for enrolled members in the various...+ Capture and document annual diagnoses accurately consistent with Medicare risk adjustment . + Conduct… more
- AmeriHealth Caritas (Newtown Square, PA)
- …as the leader responsible for driving the Quality Performance Reporting & Analytics and Risk Adjustment for Medicaid Quality, Medicare Stars, and Exchange ... and collaboration across all levels. It combines expertise in risk adjustment and quality performance, with oversight...partnerships and optimize data abstraction and management + Direct advanced analytics functions to monitor risk scores… more
- AdventHealth (Bolingbrook, IL)
- …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- ... risk populations from interdisciplinary team members (including physicians, RN...substance use and addictive disorders o Provides patient/family education, adjustment -to-illness counseling, grief counseling and crisis intervention o Provides… more
- AdventHealth (Hinsdale, IL)
- …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- ... risk populations from interdisciplinary team members (including physicians, RN...substance use and addictive disorders o Provides patient/family education, adjustment -to-illness counseling, grief counseling and crisis intervention o Provides… more
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