- WellSense Health Plan (Boston, MA)
- …and site of care optimization, to name a few), quality program performance, risk adjustment , and health equity. In designing and implementing strategy and ... reports to ACO partners and state agencies, incorporating latest market and risk adjustment simulations available from the state.Work closely and regularly… more
- WellSense Health Plan (Boston, MA)
- …and site of care optimization, to name a few), quality program performance, risk adjustment , and health equity. In designing and implementing strategy and ... works for our members, no matter their circumstances. The Director of Finance and Strategy, MassHealth Product will be...ACO partners and state agencies, incorporating latest market and risk adjustment simulations available from the state.… more
- Somatus (Mclean, VA)
- …teammates physical and mental well-being + Community engagement opportunities + And more! The Sr. Director , Medicare Risk Adjustment (MRA) will lead the ... leadership/management experience required. + Proven experience with commercial and/ or Medicare Advantage risk adjustment functions. + Proven track record of… more
- CenterWell (Carson City, NV)
- …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
- 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 ... and develops clinical strategies and educational initiatives around the impact that accurate risk adjustment has on the performance of our MA, MSSP, Medicaid,… more
- Centene Corporation (Tallahassee, FL)
- …as a medical coder **2+ years of experience** in coding with knowledge of Medicare risk adjustment (HCC Coding) Required experience in teaching, training ... analysis of practice coding patterns, education and training regarding risk adjustment to ensure accurate CMS payment...include Provider Relations, Quality as well as the Medical Director for the state assigned to ensure compliance of… more
- Highmark Health (Pittsburgh, PA)
- …Managed Care + 3 years in Budget Administration + Experience in leading Medicare Advantage risk adjustment strategies **LICENSES OR CERTIFICATIONS** ... VP of Revenue Program Management in support of governmental products where Risk Adjustment methodologies apply. Functions as the business owner of the risk… 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
- The Cigna Group (Maitland, FL)
- …Market Provider Performance, Sales, Health Services, Clinical, Stars & Risk Adjustment , Finance, Marketing, Cross-Segment Contracting, Provider Relations, ... provider partner relationships in order to drive optimal performance on Stars, risk adjustment , utilization management, and overall financial performance. +… 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
- Conviva (Tallahassee, FL)
- …business in business, healthcare administration, or related field. + Proven experience with Medicare Advantage risk adjustment functions + Proven track ... caring community and help us put health first** The Director , Medical Coding extracts clinical information from a variety...function or segment. **Strategy:** + In partnership with AVP, Risk Adjustment and AVP, MRA Strategy, responsible… more
- Conviva (Tallahassee, FL)
- …Coding Certification + Ability to Travel **Preferred Qualifications** + Proven experience with Medicare Advantage risk adjustment functions. + Proven track ... entities within the Primary Care Organization. **Strategy:** + In partnership with AVP, Risk Adjustment and AVP, MRA Strategy, responsible for driving ongoing… more
- Molina Healthcare (Starkville, MS)
- …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
- Dignity Health (Bakersfield, CA)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, ... work within PST business hours.** **Position Summary:** The Medical Director of UM reports to the Chief Physician Executive...to practice and free of sanctions from Medicaid or Medicare . - Must have Medicaid and/or Medicare … 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
- Humana (Frankfort, KY)
- …to customers + Proven experience collaborating across enterprises **Desired Qualifications** + Medicare risk adjustment or stars or experience **Additional ... role, you will support the value story for Humana's risk adjustment and Stars activities overall, as...Quality Reporting and Improvement business area, part of the Medicare and Medicaid business. With over 9 million medical… more
- Elevance Health (Nashville, TN)
- …(Operational)** The Sr. Business Consultant will support the Advanced Primary Care risk adjustment team through vendor engagement, reporting and identifying ... have a healthcare background with a strong understanding of Risk Adjustment . You should have experience in...adjustment and/or health insurance industry. + Experience in Medicare Advantage and Medicaid in a provider based 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
- 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
- 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
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