- Point32Health (Canton, MA)
- …and business division goals. This position will report to the Director of Risk Adjustment Strategy , Operations and Quality Assurance. **Job Description** ... will oversee all provider engagement and reporting activities for risk adjustment programs and initiatives that impact Medicare , Medicaid, and Duals product… more
- Ankura (New York, NY)
- …master's degree from an accredited college/university + 8+ years of experience in Medicare Risk Adjustment operations, internal audit, or compliance either ... compliance, accreditations, operations, investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment . The… more
- Elevance Health (West Des Moines, IA)
- …for completing projects and performing complex actuarial studies related to risk adjustment analytics in both the Medicaid and Medicare Advantage lines of ... develops SAS and SQL programming to support Medicaid and Medicare Advantage risk adjustment initiatives....creating a culture that is designed to advance our strategy but will also lead to personal and professional… more
- CareFirst (Baltimore, MD)
- … Manager plays a critical role in the development and execution of the corporate risk adjustment strategy . The role serves as a dedicated resource within ... the organization for Medicare Advantage, Medicaid and ACA markets, coordinating and leading... strategy by applying improvements and driving cost-effective risk adjustment actions across all organizational populations… more
- CareFirst (Baltimore, MD)
- …risks or barriers to leadership to ensure that all risk adjustment activities fully comply with Medicare , Medicaid, ACA, and state-specific regulations. ... **Resp & Qualifications** **PURPOSE:** The Risk Adjustment Coding Operations Supervisor supports...Operations Supervisor supports the execution of the corporate coding strategy across Medicare Advantage, Medicaid, and ACA… more
- Humana (Harrisburg, PA)
- …focused in the areas of Provider Contracting, Provider Engagement and Quality, Risk Adjustment , Clinical, and Financial Operations. + Leadership development, ... initiatives to fruition. This includes the following key responsibilities: + Develop product strategy for annual Medicare Advantage plan filings + Lead the… more
- Point32Health (Canton, MA)
- …for key initiatives + Serve as the key liaison for Actuarial, Finance, Risk Adjustment , Corporate Data and Analytics, Medical Cost Management, and Pharmacy ... years in Medicare Advantage, Medicaid managed care, or healthcare product strategy . + Preferred: 5 years of experience with D-SNPs or dual-eligible populations.… more
- Convey Health Solutions (Fort Lauderdale, FL)
- …+ Lead Product Strategy : Define and execute the roadmap for the Medicare Advantage Risk Adjustment solution, ensuring alignment with company goals ... a highly skilled and results-driven Senior Product Manager to lead our Medicare Advantage Risk Adjustment solution portfolio. In this critical role, you will… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …and vendor performance relative to established contracts. * Collaborate with actuarial, finance, Medicare and risk adjustment to ensure all inputs and ... to support Medicare network reviews. Inform the Medicare VBC strategy by projecting Medicare...Works closely with actuarial, finance, data & analytics, stars, risk adjustment , and other lever owners to… more
- Molina Healthcare (Iowa City, IA)
- …Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Drives provider ... place and carried out to meet annual quality & risk adjustment performance goals.** **Job Duties** +...Healthcare. + 1 year of experience in Medicaid and/or Medicare managed care To all current Molina employees: If… more
- Humana (Montgomery, AL)
- …leaders and their respective functions with a focus on Provider Engagement, Quality and Medicare Risk Adjustment . Represents the health plan externally and ... is responsible for the overall success of Stars and Risk Adjustment strategy and performance...teams. + Strong knowledge and understanding of Stars and Medicare Risk Adjustment . + Ability… more
- ChenMed (Miami, FL)
- …+ Comprehensive knowledge of Medicare program including but not limited to Risk Adjustment processes and Fee For Service. + Knowledge of applicable federal, ... Revenue Cycle Management (RCM) Optimization manages and organizes revenue strategy activities to maximize cash flow through the creation...incumbent also serves as a subject matter expert on risk - adjustment and medical economics to aid in… more
- Point32Health (NH)
- …and will work in a matrix environment collaborating with functions including risk adjustment , population health, finance, operations, actuarial, and sales. **Job ... **Job Summary** The Director of Contracting is responsible for contract strategy , development, negotiation, and implementation for hospitals, physician groups, and… more
- Humana (Little Rock, AR)
- …Business, Finance, Health Care/Administration, RN or a related field + Experience with Medicare Risk Adjustment and/or medical coding + Proven organizational ... advance their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies. Recommend execution strategies and monitor… more
- Humana (Jackson, MS)
- …assigned provider. The Senior Coding Educator is responsible for creating and executing the risk adjustment strategy for each provider groups. + Analyzes ... with relationship owners and HQRI + Monitors and develops strategy with leader and Relationship Owner, tailor's provider group...Coder (CRC) + Experience interacting with healthcare providers + Medicare Risk Adjustment knowledge +… more
- CenterWell (Jacksonville, FL)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... organizational & market priorities, trends, and goals, to develop a clinical strategy to advance clinical talent and performance + Interview, hire, and supervise… more
- CenterWell (Columbia, SC)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... organizational & market priorities, trends, and goals, to develop a clinical strategy to advance clinical talent and performance + Interview, hire, and supervise… more
- Deloitte (Los Angeles, CA)
- …reimbursement, MS-DRG, APR-DRG, PSIs, HACs, POA, Vizient, Elixhauser, public profiling, and risk adjustment + Has strong interpersonal skills to collaborate with ... Healthcare Clinical Documentation Specialist - Senior Consultant Our Deloitte Regulatory, Risk & Forensic team helps client leaders translate multifaceted risk … more
- CenterWell (Daytona Beach, FL)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... organizational & market priorities, trends, and goals, to develop a clinical strategy to advance clinical talent and performance *Interview, hire, and supervise… more
- CenterWell (Hampton, VA)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... organizational & market priorities, trends, and goals, to develop a clinical strategy to advance clinical talent and performance. + Interview, hire, and supervise… more
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