- UCLA Health (Los Angeles, CA)
- …and more at UCLA Health. As member of the Medicare Advantage Risk Adjustment leadership team, the Assistant Director of Risk Adjustment is ... the compliance officer and the manager of coding and education. The Assistant Director of Risk Adjustment will oversee the manager of the coding team and… 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 (San Bernardino, 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
- Healthfirst (NY)
- … and Medicaid Services (CMS) practices, policies, and regulations. Expert knowledge of Medicare Risk Adjustment Payment Methodology, HCC, CRG and other ... leadership to analysts and staff in support of all processes related to risk adjustment for Medicaid, Medicare & QHP products. + Direct the communication… 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 (Las Cruces, NM)
- …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
- Bristol Myers Squibb (Washington, DC)
- …every treatment we pioneer. Join us and make a difference. **Position Summary** The Director , 340B Policy Strategy, will serve as a deep technical expert in the ... plan for 340B across the BMS Enterprise . The Director will lead 340B strategies that shape public policy...with an acute focus on 340B but including other Medicare / Medicaid programs and key priority policies. +… more
- Molina Healthcare (Columbus, OH)
- …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
- Molina Healthcare (Cambridge, 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
- Ankura (Chicago, IL)
- …of regulatory and industry guidance related to medical necessity, utilization management, risk adjustment and clinical documentation requirements + Ability to ... and medical policy review and interpretation. + Conduct "mock" Centers for Medicare and Medicaid Services audits by reviewing cases for clinical decision making… 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
- 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
- Novant Health (NC)
- …Quality, Total Cost of Care, Network Integrity, Social Determinants of Health, Risk Adjustment , and Attribution. + Build compelling visualizations, innovative ... strategic goals. The Senior Analyst, Population Performance reports to the Director , Population Performance, and supports population health analysis to drive… more
- Whidbey General Hospital (Coupeville, WA)
- …in-hospital stay to discharge: When the patient and or family has specific adjustment or psych/social needs, the social worker is integrated into the care plan ... up may be indicated for patients who have been identified as high risk for re-hospitalization or non-compliance with recommended follow up care. + Facilitates… more
- St. Luke's University Health Network (Stroudsburg, 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
- AdventHealth (La Grange, 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
- AdventHealth (Daytona Beach, FL)
- …under the general supervision of the Care Managment Supervisor or Manager or Director of Nursing and is responsible for patient evaluations of post-hospital needs; ... Incorporates social determinants of health into transitions of care planning and applies risk mitigation interventions to meet the individual needs of each 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
- CenterLight Health System (NY)
- …and full capture of the burden of illness of our participants and appropriate risk adjustment . Provide feedback and counseling to DTC and IDT staff regarding ... absence of, or at the direction of, the Medical Director , the NPS will represent or serve as the...frail and/or elderly. For participants with higher levels of risk , these assessments will be performed more frequently to… more
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