- Somatus (Mclean, VA)
- …physical and mental well-being + Community engagement opportunities + And more! The Sr. Director , Medicare Risk Adjustment (MRA) will lead the execution ... experience required. + Proven experience with commercial and/ or Medicare Advantage risk adjustment functions. + Proven track record of working collaboratively… more
- The Cigna Group (Plano, TX)
- …TEXAS market - can live in Houston, San Antonio, Dallas or Plano** The ** Director , Provider Contracting - Medicare ** serves as an integral member of the ... Network Development and Strategy Team and reports to the Provider Contracting Senior Manager. This role is a key contributor to the development of the strategic… more
- The Cigna Group (Nashville, TN)
- …of the National Development and Network Solutions team, reporting directly to the Medicare National Partnerships Director . This role is a key contributor for ... and Medicare Advantage stakeholders for complex value-based and downside risk reimbursement methodologies for Medicare provider contracting matters. +… more
- Travelers Insurance Company (Columbus, OH)
- …strategies for addressing and resolving various types of debt, including Medicare , to deliver positive financial outcomes. This role requires leveraging economic ... Support: + Partners with the Field, Claim Resources and Senior Leadership to identify and improve Claim processes and...a financial management and control strategy to limit financial risk associated with claim costs. + Serves as a… more
- The Cigna Group (St. Louis, MO)
- …Risk Adjustment Operations Senior Advisor will report to the Stars and Risk Adjustment Managing Director and will be responsible for internal and external ... actions into a synthesized set of business updates and strategies for a senior executive-level audience. Ideally this high-potential candidate uses this role as a… more
- Banner Health (Phoenix, AZ)
- …Health Services Organization (PHSO), will serve as the clinical DYAD to the Executive Director of Risk Adjustment, co-leading a robust team that will support the ... and develops clinical strategies and educational initiatives around the impact that accurate risk adjustment has on the performance of our MA, MSSP, Medicaid, and… more
- CenterWell (Carson City, NV)
- …of our caring community and help us put health first** The Associate Director , Risk Adjustment oversees quality assurance audits of medical records, ICD-10-CM, ... (CMS), other payers, and over government agencies. In addition, the Associate Director , Risk Adjustment oversees all medical coding education activities. The… more
- Prime Therapeutics (Columbus, OH)
- …vision, depth perception and ability to adjust focus **Reporting Structure** + Reports to Senior Principal or Senior Director in the Finance department ... and drives every decision we make. **Job Posting Title** Principal Actuary - Medicare Part D - Remote **Job Description** The Principal Actuary is responsible for… more
- The Cigna Group (Atlanta, GA)
- …Relations, and Network Development & Solutions). Reporting to the Network Operations Senior Manager or Director , this individual ensures the effective ... network for his/her assigned sub-market and/or provider groups. The role of Senior Advisor with the Provider Performance Enablement team takes ownership for… more
- HCA Healthcare (Nashville, TN)
- …Do you want to join an organization that invests in you as a Senior Director Regulatory and Accreditation? At HCA Healthcare, you come first. HCA ... make a difference. We are looking for a dedicated Senior Director Regulatory and Accreditation like you...and provides guidance to division vice president, quality or director , quality and risk management *Daily prioritization… more
- ChenMed (Detroit, MI)
- …and mission-driven, primary care organization, is currently one of the most successful full- risk Medicare Advantage providers in the nation and has a vision ... position towards becoming a center clinical P&L leader (ie, Senior Medical Director [SMD]) in the organization....each patient in their panel of at least 300 risk adjusted patients (75% partial panel). They understand that… more
- The Cigna Group (Maitland, FL)
- …Market Provider Performance, Sales, Health Services, Clinical, Stars & Risk Adjustment, Finance, Marketing, Cross-Segment Contracting, Provider Relations, and ... Network Development & Solutions). Reporting to the Provider Performance Director , the Provider Performance Manager ensures the effective management of the… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …national antifraud associations. The attorney will also oversee compliance for the Medicare and Federal Employee programs related to FWA and respond to Compliance, ... CMS and OPM requests and audits. The attorney will provide risk management advice, legal advice and litigation services to other areas of the Blue Cross as needed.… more
- ConvaTec (Bridgewater, NJ)
- …all the time. We're a business that never stands still. Join the team as the Director / Senior Director , US Policy and Global Market Access and Reimbursement - ... range of benefits, from infection prevention and protection of at- risk skin, to improved patient outcomes and reduced care...note, this position could be hired at either a Director or Senior Director level… more
- The Mount Sinai Health System (New York, NY)
- …for value-based contracts including Medicare , Medicaid and commercial arrangements. The Senior Director is a key member of Mount Sinai Health Partners, ... **JOB DESCRIPTION** The Senior Director , Contract Performance is responsible...implementing and driving performance for value-based contracts inclusive of risk and opportunity identification for Medicare , Medicaid… more
- The Cigna Group (Philadelphia, PA)
- …Stars and RA goals and objectives. This position reports to the Managing Director of Stars, Risk Adjustment, and Interoperability. The successful candidate for ... other day of choosing)** **Summary:** This position will focus on Stars and Risk Adjustment (RA) performance and solution enablement activities, with an emphasis on… more
- CareOregon (Portland, OR)
- …in the provider network. Essential Responsibilities + In partnership with the Senior Medical Director and/or other Medical Directors, develop, implement, and ... quality of care for a special needs, dually eligible Medicare population by understanding and applying D-SNP Medicare...and appeals for medical and pharmacy as assigned by Senior Medical Director or CMO. + May… more
- Billings Clinic (Billings, MT)
- …Disproportionate Share Hospital (DSH) programs. Monitors DSH eligibility and communicates any risk to senior leadership as appropriate. * Establishes best ... to starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Executive Director of Reimbursement REIMBURSEMENT (Billings Clinic Main Campus) req8385… more
- CareOregon (Portland, OR)
- …network. Essential Responsibilities + In partnership with the CCO Medical Directors, Senior Medical Director and/or other Medical Directors, the Quality Health ... Quadruple Aim. Direct support may be focused on Medicaid, Medicare , or Maternal, Child, and Youth Strategy lines of...for medical and pharmacy as assigned by CCO Medical Director , Senior Medical Director or… more
- Magellan Health Services (Dallas, TX)
- …clinical quality improvement activity (QIA) in collaboration with the clinical lead senior medical director , and quality improvement staff. May participate in ... the health plan(s) for all lines of business (Medicaid, Medicare , and Commercial) and implements programs to support this...various committees or project teams as directed by the senior medical director or vice-president. + Supports… more