- CVS Health (Hartford, CT)
- …portfolio of Aetna Better Health Medicaid Plans. Reporting to the Senior Manager of Medicaid Risk Adjustment , the Market Manager of Medicaid ... retain a high performing, high quality risk adjustment talent pool that is respected within Medicaid...2+ years of experience in the health care industry, Medicaid operations, risk adjustment , or… more
- CVS Health (Northbrook, IL)
- …to the Provider Engagement Lead Director of Medicaid Risk Adjustment Provider Engagement , the Manager will work closely with cross-functional leadership ... aimed at fostering meaningful collaborations with healthcare providers and aligning the Medicaid Risk Adjustment initiatives to broader Aetna Medicaid … more
- CVS Health (Hartford, CT)
- …the Aetna Better Health Medicaid Plans. Reporting to the Lead Director of Medicaid Risk Adjustment National Programs, this individual will work closely ... years of project management experience. Preferred Qualifications + 2+ years in Medicaid or Risk Adjustment health care industry experience. + Certified … more
- CVS Health (Hartford, CT)
- …economic outcomes, and other business needs. Reporting to the Sr. Manager of Medicaid Risk Adjustment Analytics, the Sr. Analyst will work closely with ... to make health care more personal, convenient and affordable. Position Summary The Medicaid Risk Adjustment Sr. Analyst will play a critical role in… more
- CareOregon (Portland, OR)
- Job Title Risk Adjustment Analytics Manager Exemption Status Exempt Department Finance Manager Title Director, Risk Adjustment Direct Reports ... Responsible for the development, execution, and management of the risk adjustment data analytics programs for the... data analytics programs for the Medicare Advantage and Medicaid programs. Assists Director in developing a long-term plan… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Risk Adjustment Manager plays a critical role in the development and execution of the corporate risk ... leading the end-to-end strategy by applying improvements and driving cost-effective risk adjustment actions across all organizational populations and products.… more
- CVS Health (Dover, DE)
- …more personal, convenient and affordable. Position SummaryThe Revenue Integrity (RI) Sr. Manager , Business Consultant ( Risk Adjustment ) is responsible for ... leadership Required Qualifications + 3-5 years of Risk Adjustment experience Medicare, IFP, and/or Medicaid + Core understanding of Risk Adjustment … more
- Point32Health (Canton, MA)
- …this individual will be responsible for supporting critical data submission functions for the Risk Adjustment Department (RAD) including risk adjustment ... and timely resolution of production issues pertaining to CMS and risk adjustment data submission, including issue investigation, business requirements,… more
- Highmark Health (Columbus, OH)
- …Medicare Advantage, Medicaid , Affordable Care Act + Demonstrated knowledge of risk adjustment principals + Health Insurance and/or managed care industry ... time and budget and under circumstances involving multiple moderate-probability, moderate-impact risk factors. Manages a matrix group of employees and contractors… more
- CareOregon (Portland, OR)
- …Advantage bid; advise internal leadership on potential bid pricing strategies. + Collaborate with Risk Adjustment team to monitor risk adjustment applied ... Nevada, Texas, Montana, or Wisconsin. Job Title Actuarial Services Manager - Medicaid and Medicare Exemption Status...of Medicare Advantage bid process + Understanding of various risk adjustment methodologies (eg CDPS+Rx, CMS-HCC, ACG,… more
- AdventHealth (Maitland, FL)
- …to comply with State Medicaid and CMS regulations with respect to Risk Adjustment rules and working with outside vendors to ensure their compliance. ... incentive programs, and develop and lead a broad and diversified range of risk adjustment coding services for the AdventHealth Population Health Ri Clinical… more
- Molina Healthcare (Las Vegas, NV)
- **JOB DESCRIPTION** **Job Summary** Responsible for continuous quality improvements and risk adjustment accuracy for all government lines of business. Supports ... to engage with key providers. + Participates in state level quality and risk adjustment strategy meetings, develops a quality workplan, and ensures integration… more
- WellSense (Boston, MA)
- …teams to capture, value, and scorecard medical cost savings initiatives. + Leads risk adjustment analyses and risk score simulations. + Leads ... Manager of Actuarial Services WellSense Health Plan is...and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded 25 years ago as Boston Medical… more
- MarketSource (Alpharetta, GA)
- 121666BRTitle:Compliance ManagerJob Description: Compliance Manager (Insurance) MarketSource Inc., an Allegis Group Company, develops and delivers innovative managed ... Summary Responsible for leading a team and driving regulatory compliance and risk mitigation efforts through the organization, by identifying risk areas… more
- Deloitte (Albany, NY)
- …Medicaid waivers (ie, 1115, 1915 b/c, 1332) + 1+ years experience with risk adjustment mechanisms + 1+ years experience with Provider reimbursement streams ... Work you'll do As a Deloitte Consulting Health Actuary Manager in Deloitte's GPS Human Capital Actuarial and Insurance...Bachelor's Degree Required + 3 years + experience with Medicaid managed care rate setting + ASA with progression… more
- LA Care Health Plan (Los Angeles, CA)
- …Performance Management QI/QPM and Health Information Management (HIM) analytics support, Risk Adjustment , other plan operations business units, and network ... Clinical Quality Program Manager II (CAHPS) Job Category: Clinical Department: Quality...not limited to QI, Pharmacy, Care Management, Utilization Management, Risk Adjustment , Products, Customer Solution Center (CSC),… more
- LA Care Health Plan (Los Angeles, CA)
- Manager , Encounters Job Category: Administrative, HR, Business Professionals Department: Risk Adjustment Strategies & Initiatives Location: Los Angeles, CA, ... net required to achieve that purpose. Job Summary The Manager of Encounter Data is responsible for coaching staff...The position requires communicating with Centers for Medicare and Medicaid Services (CMS), The California Department of Health Care… more
- CareOregon (Portland, OR)
- …Actuaries + Experience with Medicaid and Medicare + Experience estimating IBNR, risk adjustment transfers, and other health care liabilities and assets + ... Nevada, Texas, Montana, or Wisconsin. Job Title Actuarial Services Manager - Corporate Exemption Status Exempt Department Finance ...+ Ability to work with eligibility data, claims data, risk scores, and other financial data + Ability to… more
- Vatica Health (Seattle, WA)
- …coding, healthcare billing, quality and Value Based Care measures and metrics. Risk Adjustment knowledge/experience is preferred. + Understanding of Medicare, ... The Manager of Clinical Operations leads and manages the Clinical...ACD, Medicaid , and health plan benefit structures. + Strong management experience… more
- CareOregon (Portland, OR)
- …Agile methodology Preferred: + Experience with Encounter Management and Risk Adjustment Cycle Management + Experience with Medicaid and Medicare programs + ... Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title IS Development Manager - EDI Exemption Status Exempt Department Business Intelligence Manager … more