- 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
- Universal Health Services (Reno, NV)
- …and enhancing the patient experience. Learn more at: https://prominence-health.com/ Job Summary: The Risk Adjustment Submissions Manager is a core member of ... to manage submissions and errors, applicable regulatory edits and business rules. The Risk Adjustment Submissions Manager maintains the throughput of… more
- CVS Health (Hartford, CT)
- …has an exciting opportunity for a Senior Informatics Manager to join our dynamic Medicaid Risk Adjustment Analytics team! In this role you will provide ... of audiencesPreferred Qualifications- Knowledge of government-regulated healthcare programs such as Medicaid or Medicare - Risk Adjustment … 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
- CVS Health (Tallahassee, FL)
- …diagnosis coding, and/or auditing. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories ... Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in… more
- CVS Health (Woonsocket, RI)
- …actuarial team for forecasting and rate setting; serve as lead subject matter expert on Medicaid Risk Adjustment methodology and risk scoring; maintain ... is hiring for the following role in Woonsocket, RI: Manager , Informatics to formulate and apply mathematical and optimizing...risk evaluation and program implementation; track and analyze risk adjustment model versions and weights by… 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 (Stamford, CT)
- …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 + 1+ years experience… 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
- Humana (Columbus, OH)
- …similar **Preferred Qualifications** + Knowledge and/or experience within the Stars Organization, Risk Adjustment and/or Provider. + PMP or CAPM Certification + ... of our caring community and help us put health first** The Senior Product Manager Conceives of, develops, delivers, and manages products for customer use. The Senior… 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
- Marshfield Clinic (Marshfield, WI)
- …Specialist position conducts quality assurance activities to ensure the accuracy and integrity of risk adjustment data submitted to the Centers for Medicare & ... Medicaid Services (CMS) and Department of Health Services (DHS);...Coding Guidelines, CMS Medicare, HHS, and DHS BadgerCare Plus risk adjustment policy and Hierarchical Condition Category… 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
- Trinity Health (Fresno, CA)
- …Trinity practices and policies. Partners with leadership to improve HCC and other Risk Adjustment capture with provider and coder education. Conducts ongoing ... **Employment Type:** Full time **Shift:** Day Shift **Description:** Reporting to the Manager Medical Group Revenue Cycle Site Operations, Fresno, this position is… more
- Commonwealth Care Alliance (Boston, MA)
- …+ Maintain current industry knowledge of highly impactful external audits such as Risk Adjustment Data Validation Audit, CMS Program Audit protocols, common ... + Contribute towards the maintenance and enhancement of an effective Compliance Risk Assessment Program + Project manage regulator and other external reviews as… more