- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- Ready to help us transform healthcare? Bring your true colors to blue. The Medicare Risk Adjustment Strategy Program Manager will report to the Senior ... Director of Medicare Risk Adjustment and Analytics....Director of Medicare Risk Adjustment and Analytics. This role will... performance that will assess the progress of the risk adjustment strategy + Develop… more
- Elevance Health (Woodbridge, NJ)
- ** Medicare Risk Adjustment Advanced...creating a culture that is designed to advance our strategy but will also lead to personal and professional ... an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Advanced Analytics...of our culture. They are how we achieve our strategy , power our business outcomes and drive our shared… more
- Elevance Health (Louisville, KY)
- ** Medicare Risk Adjustment Advanced...creating a culture that is designed to advance our strategy but will also lead to personal and professional ... an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Advanced Analytics...of our culture. They are how we achieve our strategy , power our business outcomes and drive our shared… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …The role is responsible for the strategy , execution and performance of Medicare risk adjustment reporting and analytics, infrastructure and systems to ... Bring your true colors to blue. Under the direction of the Senior Director of Medicare Risk Adjustment and Analytics, the Associate Director of Risk … more
- Corewell Health (Grand Rapids, MI)
- …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 adjustment strategies as applicable. Success will require competence in risk adjustment strategy , an ability to build and scale risk… more
- Marshfield Clinic (Marshfield, WI)
- … Risk Adjustment Revenue Director is a finance leader responsible for risk adjustment strategy and related revenue management for Sanford Health ... Plan's Medicare , Affordable Care Act and Medicaid business and reports...as Sanford Health Services executives and leadership to lead risk adjustment strategy and process.… more
- Blue KC (Kansas City, MO)
- … adjusted revenue optimization strategy and oversight of Government Programs Risk Adjustment programs. **Job Description** + Interface with Blue KC ... and quality coding. + Provide Government Programs oversight to ensure Medicare Advantage and ACA Risk Adjustment and state regulations are maintained. +… 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 ... 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
- CareFirst (Baltimore, MD)
- …are: direct and indirect reports and vendors. Prioritize work in alignment with Risk Adjustment strategy , business goals, organizational strategies and ... oversees the outcomes and operations of risk adjustment across the organization within Medicare Advantage, Medicaid & ACA markets. The Risk … 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… 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
- AmeriHealth Caritas (Newtown Square, PA)
- …Summary** Reporting to the Senior Vice President, the Vice President, HEDIS / Stars Risk Adjustment Performance Strategy serves as the leader responsible for ... driving the Quality Performance Reporting & Analytics and Risk Adjustment for Medicaid Quality, Medicare...and Exchange QRS. This leader is accountable for driving strategy and insights for the local markets' quality intervention,… 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
- Molina Healthcare (Madison, WI)
- …+ Establishes strategy and operational direction for engaging providers on risk adjustment & quality improvement in collaboration with the Plan President, ... , and Network team. + Collaborates with Health Plan Network to drive value-based care strategy related to risk adjustment & quality. + Sets Health Plan… more
- CenterWell (Baton Rouge, LA)
- …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 (Syracuse, 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
- 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
- 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
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