- Somatus (Mclean, VA)
- Overview The Director , Medicare Risk Adjustment (MRA) will lead the execution strategy and implementation of the organization's Risk Adjustment ... customer service, enrollment etc. + Proven experience with commercial and/ or Medicare Advantage risk adjustment functions. + Proven track record of working… more
- Elevance Health (Woodland Hills, CA)
- ** Director of Medicare Risk Adjustment Analytics and Reporting** **Location:** This position will work a hybrid model (remote and office). The ideal ... PulsePoint location in Woodland Hills, CA. The ** Director of Medicare Risk Adjustment Analytics and Reporting** is responsible for planning, directing… more
- CVS Health (Jackson, MS)
- …to make health care more personal, convenient and affordable. As the Senior Manager, Risk Adjustment ( Medicare ) will be responsible for leading Risk ... Adjustment for the Georgia & the Gulf States Medicare Market, specifically in Mississippi. This role will have...working with providers. This position reports to the Lead Director of Risk Adjustment for… more
- CVS Health (Atlanta, GA)
- …to make health care more personal, convenient and affordable. As the Senior Manager, Risk Adjustment ( Medicare ) will be responsible for leading Risk ... Adjustment for the Georgia & the Gulf States Medicare Market. This role will have specific responsibility for...working with providers. This position reports to the Lead Director of Risk Adjustment for… more
- Martin's Point Health Care (Portland, ME)
- …refinement, maintenance, monitoring and oversight of Medicare Risk Adjustment initiatives and operations. The Senior Director is also responsible for ... been certified as a "Great Place to Work" since 2015. Position Summary The Senior Director of Risk Adjustment Operations in our Health Plan is responsible… more
- Trinity Health (Fort Lauderdale, FL)
- …Expertise in Medicare programs and regulations including fraud and abuse and Medicare Hierarchical Condition Coding Risk Adjustment + Excellent analysis ... or perform data mining and data-driven analysis to forecast/evaluate the performance of the risk adjustment program and refine annual risk adjustment … more
- Centene Corporation (Columbia, SC)
- …as a medical coder 2+ years of experience in coding with knowledge of Medicare risk adjustment (HCC Coding) Required Other experience in teaching, ... include Provider Relations, Quality as well as the Medical Director for the state assigned to ensure compliance of...2+ years of experience in coding with knowledge of Medicare risk adjustment (HCC Coding)… more
- Centene Corporation (Carson City, NV)
- …as a medical coder. 2+ years experience in coding with knowledge of Medicare risk adjustment (HCC Coding). Required experience- teaching, training ... analysis of practice coding patterns, education and training regarding risk adjustment to ensure accurate CMS payment...include Provider Relations, Quality as well as the Medical Director for the state assigned to ensure compliance of… more
- CVS Health (Hartford, CT)
- …years of relevant financial experience + Knowledge of: Financial Management, Expense Management, Medicare Bids, Stars, Risk Adjustment + Skill In: Ability ... Integrity teams for each of the 4-5 regions that Medicare operates under. This organization will help strengthen the...business partners the expansion of VBC, Provider Collaboration (ie Risk deals) across the local markets. Ensure deals are… more
- Elevance Health (Richmond, VA)
- …practice managers, population health and quality directors on improving STARS/HEDIS or Risk Adjustment performance. + Six Sigma or formal process improvement ... a proud member of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also provide administrative services to Medicaid… more
- Elevance Health (Columbus, OH)
- …faith-based, community-based, and special needs initiatives. + Oversee Stars and Risk Adjustment performance and local market strategies with providers ... **RVP & President Medicare Market (Ohio)** **Location:** This role requires the...medical staffing, seasonality issues, detailed communications with the medical director , and nurse leader. Collaborate with HSO and Carelon… more
- Universal Health Services (Reno, NV)
- …programs. + At least 3 years of health care experience working with Medicare and/or Commercial risk adjustment programs. Requires working knowledge ... strategies within the Prominence Health umbrella. Emphasis will be centered around risk -based contract performance, risk adjustment , and quality measurement… more
- Providence (Portland, OR)
- …Demonstrated expertise in budgeting and forecasting techniques. + Demonstrated knowledge in risk adjustment models (commercial, ACA, Medicare , and Medicaid) ... budgeting, projecting provider risk sharing and alternative payment amounts, and estimating risk adjustment and risk transfer payment amounts. + Key… more
- Mitsubishi Chemical Group (Jersey City, NJ)
- …on real-world evidence, and creating hope for all facing illness. The Director , Government Accounts will be responsible for the development and implementation of ... imperatives and tactical planning for targeted government channels: CMS, Medicare Part B MAC's, VA, DOD and Tricare East...pull through with the field Sales and Marketing. The Director , Government Accounts will maintain a high level of… more
- VIP Care (Tampa, FL)
- …Electronic Medical Record (EMR) system to review Patient records + Proficiency in Medicare Risk Adjustment + Effective communication and interpersonal skills ... Summary/Objective: The Senior Medical Director is responsible for leading efforts to develop...performance improvement strategies to ensure success in our existing ( Medicare Advantage) as well as net new LOBs. They… more
- Commonwealth Care Alliance (Boston, MA)
- …activities and reviews, including claims reviews; call center and digital communications reviews; Medicare Risk Adjustment , HCC, clinical and coding reviews; ... This Role is Important to Us:** **Position Summary:** The Director , Quality & Control Assurance reports to the VP...of Quality & Control Assurance policies & procedures, SOPs, risk assessments, and work plans. + Provides clear and… more
- Molina Healthcare (Albuquerque, NM)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... **REQUIRED EXPERIENCE:** * 5 years previous experience as a Medical Director in clinical practice * 3 years' experience in Utilization/Quality Program… more
- Evolent Health (Columbus, OH)
- …analytics to drive decision making and with Hierarchical Condition Category Risk Adjustment - **Preferred** . + Leadership/ mentoring experience supporting ... as we solve complex business problems. **Collaboration Opportunities:** The Director , Actuarial utilizes and develops analytical tools to solve complex… more
- Centene Corporation (St. Louis, MO)
- …and Information Set (HEDIS) performance + Responsible for quality improvement aspects of risk adjustment processes for all products + Collaborate with ... STARS team to improve overall STARS ratings for Medicare products (including HEDIS, CAHPS, HOS) + Oversee provider...states may require a formal certification in quality improvement, risk management, or another parallel field. Current state's RN… more
- AdventHealth (Altamonte Springs, FL)
- …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 Care Managers, staff nurses, and other members of the care team). The Social Work Care… more