- Elevance Health (Atlanta, GA)
- …program areas including but not limited to: claims, grievances and appeals, Part D and risk adjustment . + Knowledge of Risk Adjustment Payment ... objectives. + Collaborates with management to set strategic vision; oversees manager(s)/ director (s) with direct reports. + Hires, trains, coaches, counsels, and… more
- CenterWell (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Associate Director , Risk Adjustment oversees quality assurance audits of medical records, ... payers, and over government agencies. In addition, the Associate Director , Risk Adjustment oversees all...related field + Well-versed in various reimbursement methodologies, including risk adjustment , fee for service, Medicare… more
- Molina Healthcare (NY)
- …+ Coordinates accountabilities between segment and markets to drive performance in network, risk adjustment , and stars; single point of contact for escalations ... to mitigate risk and develop/implement improvements across areas that impact Medicare performance. + Collaborates across Medicare segment, with health plans,… more
- Molina Healthcare (Long Beach, CA)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare ,… more
- The Cigna Group (Atlanta, GA)
- …(which includes Market Provider Performance, Sales, Clinical Operations, Stars & Risk Adjustment , Finance , Cross-Segment Contracting, Provider Relations, and ... and financial and/or operational issues with providers. + Leading Stars & Risk Adjustment outcomes through local Provider Performance initiatives. Developing and… more
- Molina Healthcare (Albuquerque, NM)
- …related to activities in all government lines of business impacted by regulatory risk adjustment payment model. Accountable for designing and implementing a ... lead to the overall achievement of improved accuracy, compliancy, and completeness in risk adjustment revenue for all government lines of business. Supports the… more
- Mount Sinai Health System (New York, NY)
- …adjustment with a group of practices and (2) close partnership with the CDQI Director to drive accurate risk adjustment throughout the system. This ... the status quo **Role Summary:** MSHP seeks a Medical Director (MD), Physician Engagement and CDQI, who will (1)...drive excellence in efficiency of care, quality and accurate risk adjustment for all populations served, especially… more
- Molina Healthcare (Louisville, KY)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in Utilization/Quality Program… more
- Centene Corporation (Austin, TX)
- …and Information Set (HEDIS) performance + Responsible for quality improvement aspects of risk adjustment processes for all products + Collaborate with ... competitive benefits including a fresh perspective on workplace flexibility. **- Medicare STARS Quality expertise heavily preferred** **-Remote opportunity** **Position… more
- Molina Healthcare (MA)
- …etc.), set annual targets for each VBP/VBC in conjunction with national quality and risk adjustment VPs, develop and produce reports for Regional Directors and ... and must live in Massachusetts _** **Job Description** **Job Summary** The Director , LTSS Partnerships plays a critical role in the development and implementation… more
- AdventHealth (Hinsdale, IL)
- …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
- AdventHealth (Shawnee, KS)
- …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...substance use and addictive disorders + Provides patient/family education, adjustment -to-illness counseling, grief counseling and crisis intervention + Provides… 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 ... Risk Assessment. + Make recommendations towards enhancements to the Continuous Compliance Risk Assessment process. + Alert Director of Internal Audit of… more
- New York State Civil Service (Middletown, NY)
- …Westchester counties weekly. This Registered Nurse 1 works under the direction of the Director of Nursing and is directly supervised by the Director of Nursing. ... in implementing program policies and procedures that eliminate the risk of infection to individuals, facility personnel, and visitors...to the policy and under the direction of the Director of Nursing.* Requirements will include, but are not… more
- St. Luke's University Health Network (Easton, PA)
- …Social Work care managers, assistants, coordinators, utilization management staff, and director . + Facilitates communication among all treatment team members. + ... patient as healthy as possible in the outpatient setting, minimizing the risk of readmissions. + Issues applicable state/federal regulatory notices as applicable… more
- St. Luke's University Health Network (Bethlehem, PA)
- …to: RN care managers, assistants, coordinators, utilization management staff, and director . + Facilitates communication among all treatment team members. + Manages ... patient as healthy as possible in the outpatient setting, minimizing the risk of readmissions. + Issues applicable state/federal regulatory notices as applicable… more
- The Cigna Group (Bloomfield, CT)
- …(which includes Market Provider Performance, Sales, Clinical Operations, Stars & Risk Adjustment , Finance , Cross-Segment Contracting, Provider Relations, and ... and financial and/or operational issues with providers. + Leading Stars & Risk Adjustment outcomes through local Provider Performance initiatives. Developing and… more
- University of Virginia (Charlottesville, VA)
- …large-scale complex initiatives, focusing on QI, Medicare Star Ratings, HEDIS and Risk Adjustment . + Prepare implement and monitor regional work plans to ... trainings on priority HEDIS quality measures, complex diagnosis documentation for improved risk adjustment , and best practice EPIC workflows to ensure patient… more
- CareFirst (Baltimore, MD)
- …expertise, drives the company-wide Quality Management program (including CMS Stars and risk adjustment ), and the ongoing development and implementation of health ... a managed care setting. + Previous experience as medical director for a health care company. + At least...health plan/payor environment, with solid understanding of Stars and risk adjustment . + Prior experience with operations… more
- AdventHealth (Hinsdale, IL)
- …under the general supervision of the Care Management Supervisor or Manager or Director of Nursing and is responsible for patient evaluations of post-hospital needs; ... social determinants of health into transitions of care planning and applies risk mitigation interventions to meet the individual needs of each patient **.**… more