- Point32Health (MA)
- …medical and business side of healthcare operations. + Ability to read and understand Medicare Advantage and ACA Risk Adjustment protocols. + Professional, ... here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the direction of the Risk Adjustment Supervisor/Manager, performs accurate and timely review and… more
- Intermountain Health (Columbus, OH)
- …and excellent verbal and written communication, presentation and analytical skills. + Demonstrated advanced knowledge of Risk Adjustment models and diagnosis ... Coding for highly regulated government insurance programs such as Medicare Advantage (MA), Medicaid, and the Affordable Care Act...the ability to learn and adapt to changes in Risk Adjustment methodology. + Advanced … more
- CVS Health (Overland Park, KS)
- …Medicare Advantage, MSSP, ACO REACH).** **What will you do?** + Evaluate the impact of Medicare quality and risk adjustment program has on our MA risk ... partners and ACOs through the use of actuarial and advanced analytics techniques + Proactively identify areas of opportunities...Medicare claims dataset -Ability to conduct actuarial and risk adjustment (CMS-HCC) analysis -Excellent oral &… more
- Humana (Columbus, OH)
- …the impact on underwriting margin. They will work collaboratively with peers across Medicare Risk Adjustment , Membership Growth Analytics, Medicare ... + Bachelor's Degree + FSA or ASA plus relevant advanced degree, recent and relevant work experience, and/or other...with member cohort/segmentation, Medicare Membership Report (MMR), Medicare Risk Adjustment (MRA), or… more
- AdventHealth (La Grange, 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
- Baylor Scott & White Health (Columbus, OH)
- **JOB SUMMARY** The Risk Adjustment Analyst Sr (Texas Medicaid Encounter Analyst) is responsible for monitoring and oversight of the end-to-end encounter ... management workflow. Supports program management activities around risk adjustment data management and submissions to...and submissions to government agencies such as Centers for Medicare and Medicaid Services (CMS) or Health & Human… more
- New York State Civil Service (Bedford Hills, NY)
- …counseling, etc. Duties Description Associate Psychologist functions as an advanced clinician and provide professional psychological services under the clinical ... substance and/or chemical abuse programs, specialized assessment (functional, personality, risk , competency, vocational, education); design and application of behavioral… more
- Intermountain Health (Las Vegas, NV)
- …physicians, advanced practice providers (APP), and other staff about documentation and risk adjustment in order to improve the accuracy of the overall ... mentor to leaders, physicians, APP's, and other staff about documentation and risk adjustment . + Reviews medical records documentation for reimbursement,… more
- St. Luke's University Health Network (Easton, PA)
- …patient as healthy as possible in the outpatient setting, minimizing the risk of readmissions. + Issues applicable state/federal regulatory notices as applicable ... ie.) Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON),...(MOON), Bundle Payment Care Initiative (BPCI) notification. + Monitors risk assessment using available tools and implements discharge interventions… more
- SSM Health (MO)
- …scoring. + Collaborates with others regardingclinical documentation improvement (CDI) and risk adjustment (mortality) findings. + Maintains knowledge of Centers ... the current health status of network patients against ever-changing risk adjusted models. Responsible for achieving improved documentation results...for Medicare and Medicaid Services (CMS) requirements related to clinical… 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
- 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
- New York State Civil Service (Thiells, NY)
- …program, may be substituted for one year of the required experience. Certificate of advanced study in a clinical field of psychology or school psychology may be ... and monitor functional behavior assessments and behavior support plans (or higher- risk behavior support plans for anyone with forensic background) for individuals… more
- Virginia Mason Franciscan Health (Federal Way, WA)
- …the Masters Social Worker include: crisis intervention, patient/family intervention, high- risk screening, brief counseling, referrals for financial or other ... discharges and engagement of appropriate agencies or community resources when high- risk patients are identified. ESSENTIAL KEY JOB RESPONSIBILITIES 1. Providing… more
- Virginia Mason Franciscan Health (Silverdale, WA)
- …the Masters Social Worker include: crisis intervention, patient/family intervention, high- risk screening, brief counseling, referrals for financial or other ... discharges and engagement of appropriate agencies or community resources when high- risk patients are identified. ESSENTIAL KEY JOB RESPONSIBILITIES 1. Providing… more
- Bristol Myers Squibb (Albany, NY)
- …Business, Health or Life Sciences, Healthcare Administration, or related field required; advanced degree (MBA, MA Public Health, PharmD, etc.) preferred + 1+ years ... experience including: + Coverage, coding, billing and payment + Medicare (NCD, IPPS, OPPS, 340B, etc.) + Medical policy,...by your state of residence, and 3) a driving risk level deemed acceptable by the Company. The starting… more
- Carle (Urbana, IL)
- …for business purposes. SKILLS AND KNOWLEDGE Required English Skills Advanced reading skillsAdvanced writing skillsAdvanced oral skillsCommunication Skills Ability to ... a therapeutic context of sensitivity to the emotional factors involved with adjustment to illness and lifestyle changes.* Offers educational and support groups.*… more
- Genesis Healthcare (Kennett Square, PA)
- …topics driving outcomes including, but not limited to: financial performance, risk adjustment , utilization management, quality performance, clinical performance, ... hours per week) Partner Engagement Manager to join our Advanced Care Organization (ACO) team. This is a 100%...care groups to optimize their success in LTC ACO's Medicare Shared Saving Program. The Partner Engagement Manager's top… more
- Insight Global (Colorado Springs, CO)
- …attitude * Comfortable traveling between facilities and working independently * Familiarity with Risk Adjustment in Value-Based Care * Utah NP License null We ... Current specialty certifications and license to practice as an Advanced Practitioner in the state of Colorado and Utah...willing to get Utah License) * Enrolled in CMS ( Medicare ) in both states * Firm understanding of the… more