- UCLA Health (Los Angeles, CA)
- Description As the Medicare Advantage Risk Adjustment Performance Improvement Consultant, you will be responsible for: + Serving as a Subject Matter Expert ... (SME) for risk adjustment with contracted IPAs + Collaborating...Five or more years of experience in healthcare analytics, strategy , and/or consulting at an IPA or health plan… more
- Elevance Health (Richmond, VA)
- …to the development and implementation of strategic initiatives aimed at improving risk adjustment outcomes. + Monitor the effectiveness of implemented solutions ... to identify trends, areas for improvement, and opportunities within Medicare markets ad provider networks. + Gather and analyze...stakeholders + Serves as a subject matter expert on Risk Adjustment programs and risk … more
- Elevance Health (Richmond, VA)
- …effectively consult and guide internal stakeholders on effective use and interpretation of risk adjustment data and KPIs + Provides expertise to lower-level ... Medicare is strongly preferred + Healthcare business knowledge related to Risk Adjustment Payment Methodology strongly preferred + Advanced skills in… more
- Humana (Salt Lake City, UT)
- …part of our caring community and help us put health first** The Director, Risk Adjustment Strategy Advancement will provide business intelligence and ... business segments and the company at large. The Director, Risk Adjustment Strategy Advancement requires...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Highmark Health (Pittsburgh, PA)
- …At least five years' direct management experience Preferred: + 5 or more years' Medicare and/or Commercial risk adjustment experience + Previous involvement ... financial returns in a fully compliant manner. Develop a Risk Management governance strategy for the Enterprise...Management: + Provide strategic leadership and management for the Risk Adjustment Accuracy Management Department. + Develop… more
- Datavant (Trenton, NJ)
- …+ Knowledge and understanding of HCC mapping and models + Experience with coding Medicare , Commercial and Medicaid risk adjustment charts + Understanding of ... Medicare , Commercial and Medicaid risk adjustment business logic and coding +...other legally protected status. At Datavant our total rewards strategy powers a high-growth, high-performance, health technology company that… more
- Datavant (Boston, MA)
- …and managing in a remote environment (2+ years) + 3+ years of experience working with Medicare , ACA, and/or Medicaid risk adjustment models + 5+ years of ... vision for healthcare. **What we're looking for:** The incoming Risk Adjustment Analytics Manager will be stepping...with other managers and the department director to set strategy and mobilize the team to be as performant… 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...Chief Actuary to lead unit development and execution of strategy through tactics, actions, processes, plans, and analytical tools… 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
- CenterWell (Tallahassee, FL)
- …at increasing clinical efficiencies, processes, education, and compliance as it relates to Medicare Risk Adjustment . Uses data-based insight to direct ... The Market Partnership and Finance Strategy Lead - MRA in the PCO risk adjustment area implements and supports strategy and targeted initiatives aimed… more
- Molina Healthcare (ID)
- …Azure, AWS, or Hadoop + 3-5 years of experience in Analysis related to HEDIS and/or Risk Adjustment + 3-5 years of experience in working with complex data to ... Educates users on how to use reports related to Risk and Quality/HEDIS for Medicaid, Marketplace and Medicare...users on how to use reports + Builds intervention strategy reporting for the Risk and Quality… more
- AdventHealth (Maitland, FL)
- …Accountable for improvement in clinical documentation accuracy through oversite of the risk adjustment team, including accountability for: o Ensuring clinical ... also oversee the improvement of clinical documentation accuracy for Medicare and Exchange members. While under the direction of...in place for the accurate and complete reporting of Risk Adjustment Factor (RAF) scores. o Driving… more
- CenterWell (Des Moines, IA)
- …within the Primary Care Organization. ** Strategy :** + In partnership with AVP, Risk Adjustment and AVP, MRA Strategy , responsible for driving ongoing ... Documentation (APD) tool) + Responsible for performance management and strategy development for PCO risk adjustment...up to 20% **Preferred Qualifications** + Proven experience with Medicare Advantage risk adjustment functions.… more
- Molina Healthcare (Buffalo, NY)
- …Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Ensures the ... Plan have engagement plans to meet annual quality and risk adjustment goals. Drives coaching and collaboration...Min 3 years experience improving Quality performance for Medicaid, Medicare , and/or ACA Marketplace programs To all current Molina… more
- Molina Healthcare (Detroit, MI)
- …Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Ensures the ... 2 and Tier 3 providers have engagement plans to meet annual quality and risk adjustment goals. Drives coaching and collaboration with providers to improve… 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 ... purposes of assessing our performance and the potential for improvement. + Monitor risk adjustment applied to capitation revenue and ensure population risk… more
- AmeriHealth Caritas (Newtown Square, PA)
- …quality across Specialty Products. + Analyze Medicare and Medicaid claims, enrollment, risk adjustment , and provider network data using SQL and/or SAS. + ... reimbursement methodologies. + Familiarity with predictive analytics, machine learning, and risk adjustment models. + Understanding of CMS regulations, HIPAA,… more
- CenterWell (Phoenix, AZ)
- …care, especially Medicare Advantage, with familiarity of HEDIS/STARS, medical risk adjustment , and clinical programming in primary care, complex care, ... strong emphasis on senior-focused primary care for members of Medicare Advantage health plans and is committed to providing...develop and support the MSO's National Clinical Vision and Strategy , directly lead a team of regional & area… more
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