• Risk Adjustment Coder II

    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
    Point32Health (10/09/24)
    - Save Job - Related Jobs - Block Source
  • HCC Coding Analyst Supervisor

    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
    Intermountain Health (11/06/24)
    - Save Job - Related Jobs - Block Source
  • Actuarial Manager, Accountable Care

    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
    CVS Health (11/02/24)
    - Save Job - Related Jobs - Block Source
  • Actuary, Member Mix and Underwriting Margin…

    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
    Humana (10/29/24)
    - Save Job - Related Jobs - Block Source
  • Social Work Care Manager

    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 (10/12/24)
    - Save Job - Related Jobs - Block Source
  • BSWHP - Tx Medicaid Encounter Analyst

    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
    Baylor Scott & White Health (11/06/24)
    - Save Job - Related Jobs - Block Source
  • Associate Psychologist (NY Helps), Central New…

    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
    New York State Civil Service (10/26/24)
    - Save Job - Related Jobs - Block Source
  • Clinical Documentation Specialist

    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
    Intermountain Health (11/02/24)
    - Save Job - Related Jobs - Block Source
  • Inpatient Registered Nurse or Social Worker (MSW)…

    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
    St. Luke's University Health Network (10/29/24)
    - Save Job - Related Jobs - Block Source
  • RN-Clinical Documentation Specialist, Level 2…

    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
    SSM Health (10/10/24)
    - Save Job - Related Jobs - Block Source
  • Sr. Associate, Internal Audit

    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
    Commonwealth Care Alliance (11/02/24)
    - Save Job - Related Jobs - Block Source
  • Senior Manager, Practice Innovation

    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
    University of Virginia (11/07/24)
    - Save Job - Related Jobs - Block Source
  • Psychologist 2

    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
    New York State Civil Service (10/04/24)
    - Save Job - Related Jobs - Block Source
  • Masters Social Worker

    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 (11/06/24)
    - Save Job - Related Jobs - Block Source
  • Masters Social Worker

    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
    Virginia Mason Franciscan Health (10/21/24)
    - Save Job - Related Jobs - Block Source
  • Cell Therapy Market Access Manager, Northeast

    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
    Bristol Myers Squibb (11/07/24)
    - Save Job - Related Jobs - Block Source
  • Social Worker - Home Care

    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
    Carle (10/01/24)
    - Save Job - Related Jobs - Block Source
  • Partner Engagement Manager

    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
    Genesis Healthcare (10/29/24)
    - Save Job - Related Jobs - Block Source
  • Nephrology Nurse Practitioner

    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
    Insight Global (09/26/24)
    - Save Job - Related Jobs - Block Source