- Medical Mutual of Ohio (OH)
- … Supplement, and individual plans. _Collaborates with internal departments on risk adjustment coding strategies, HEDIS performance, provider performance, and ... agreements.** + **Acts as project manager over large internal risk adjustment projects (eg, Optum In Office...& Certifications** + **Strong knowledge of the MarketPlace and Medicare within a managed care insurance industry.** + **Knowledge… more
- Molina Healthcare (Milwaukee, WI)
- …medical plan of care and capture diagnoses for Medicare risk adjustment . The NP/PA will utilize advanced assessment skills to diagnose and manage chronic ... member health outcomes. The NP/PA is responsible for completing advanced practice consultations for enrolled members in the various...+ Capture and document annual diagnoses accurately consistent with Medicare risk adjustment . + Conduct… more
- Medical Mutual of Ohio (OH)
- …of life. **Responsibilities** **Medical Record Retrieval Specialist** Supports the company's risk adjustment projects by collaborating with vendors and provider ... offices/facilities to retrieve medical records. Supports other initiatives related to Risk Adjustment Programs (RAPS) and Healthcare Effectiveness Data and… 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 (Louisville, KY)
- …advancing the care experience of our members and provider partners through integrated risk adjustment (RA) and quality (Stars) solutions that leverage data and ... customers and delivering high plan quality as rated by the Centers for Medicare and Medicaid Services (CMS).The CMS Stars quality rating system evaluates Medicare… more
- AdventHealth (Overland Park, KS)
- …communities of southeastern Johnson County, with 24/7 emergency room services, an advanced imaging center, physical therapy and more. **The role you'll contribute:** ... 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-… 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 (Bolingbrook, 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...substance use and addictive disorders + Provides patient/family education, adjustment -to-illness counseling, grief counseling and crisis intervention + Provides… 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
- AdventHealth (Bolingbrook, 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...substance use and addictive disorders o Provides patient/family education, adjustment -to-illness counseling, grief counseling and crisis intervention o Provides… more
- reveleer (OH)
- …8-10+ years' experience in a customer-facing account or vendor management role, managing Risk Adjustment projects specific to Medicare , Medicaid, and ... fast-growing technology-enabled services company that powers performance/quality measurement and risk adjustment solutions in healthcare. Specifically, Reveleer… more
- Novant Health (NC)
- …Quality, Total Cost of Care, Network Integrity, Social Determinants of Health, Risk Adjustment , and Attribution. + Build compelling visualizations, innovative ... performance opportunity identification. + Maintain a working knowledge of Medicare , Medicaid, and commercial insurance products and value-based care incentive… 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 (Stroudsburg, 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
- Molina Healthcare (TX)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... performance is achieving desired results + Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare **Job Qualifications** **Required… more
- New York State Civil Service (Thiells, NY)
- …and monitor functional behavior assessments and behavior support plans (or higher- risk behavior support plans for anyone with forensic background) for individuals ... Informed Consent Committees (ICC) for approval. Present plans to Risk Management Committee if anyone has a Higher ...for one year of the required experience. Certificate of advanced study in a clinical field of psychology or… 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
- 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 (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
- Healthfirst (NY)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRGs), ... is achieving desired results. + Keep abreast of New York Medicaid and Medicare reforms and their impact on Healthfirst and their owner hospital performance.… more
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