- The Cigna Group (Bluffton, SC)
- …audit. **Qualifications:** Bachelor's degree or equivalent. **5+ years of experience with Medicare Risk Adjustment-is required.** 5+ years of experience working ... with Risk Adjustment Data Validation Audits required. Strong knowledge of Medicare Risk Adjustment regulations required. Strong knowledge of Risk … more
- Elevance Health (Atlanta, GA)
- …required. **Preferred Skills, Capabilities and Experiences** + Knowledge and understanding of Medicare rules and regulations for program areas including but not ... design, develop and lead activities to ensure an effective Compliance program . + Oversees programs for multiple departments/functions with numerous stakeholders and… more
- Centene Corporation (Cheyenne, WY)
- …Master's degree preferred. + 5+ years project implementation, product or program management experience. + Medicare Supplement Benefits (Dental, Vision, ... a fresh perspective on workplace flexibility. **Position Purpose:** Promote increased program efficiency, service levels, and value by leading the dental, vision… more
- CVS Health (Southfield, MI)
- …include, but are not limited to: * Lead and implement an effective Compliance Program as described in CMS Medicare Managed Care Manuals and applicable Medicaid ... three days onsite per week in Southfield, MI The Sr. Compliance Manager is an experienced/career level compliance position that applies compliance, regulatory,… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …plans. Implements and manages the implementation and daily operation of the Medicare Advantage Compliance Program and all compliance-related activities for the ... approvals and/or submission to regulatory bodies or others if required. . Participate in risk assessment activities relative to Medicare Advantage Parts C and D.… more
- The Cigna Group (Birmingham, AL)
- Cigna Supplemental Benefits (CSB) has been growing rapidly with Medicare Supplement (MedSupp) annual revenues now exceeding $1.2b. The Medicare Supplement ... new business pricing strategy to drive profitable growth in the Medicare Supplement marketplace. Effectively communicate pricing strategy, positions, and changes to… more
- Healthfirst (NY)
- …personalized role-based materials and resources + Design and Execute a Comprehensive Coaching Program for new hires + Supports the creation and delivery of new video ... maximizing opportunities and increasing recertification and retention rates across the Medicare Portfolio of Products + Helps remediate learning gaps identified… more
- CVS Health (Hartford, CT)
- …and resource allocations to ensure efficient and effective plan. + Conducts program implementation risk assessments and develops mitigation strategies to ... successful execution and delivery associated with leading large scale Medicare Part D product benefit implementation inclusive of testing...for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed… more
- The Cigna Group (Sunrise, FL)
- …HEDIS, Risk Adjustment and medical expense reduction, specific to Medicare Advantage requiredAbility to apply an enterprise mindset with business acumen ... conduit to the providers and the individual that represents Cigna Medicare Advantage. The Provider Performance Enablement Lead Analyst's responsibilities include: +… more
- The Cigna Group (Seattle, WA)
- …STARS, HEDIS, Risk Adjustment and medical expense reduction, specific to Medicare Advantage required + Ability to apply an enterprise mindset with business ... topics including, but not limited to: preventative and quality outcome metrics, risk adjustment, medical cost management, etc. + Schedules, prepares for and… more
- The Cigna Group (Franklin, TN)
- …STARS, and Risk Adjustment Analytics team. Reporting to the Senior Manager of Clinical & Customer Data Science, the data scientist will analyze healthcare ... **Summary** The Data Scientist Lead Analyst will contribute to the Medicare Clinical and Customer strategy, performing research and analysis within the Clinical,… more
- The Cigna Group (Atlanta, GA)
- …includes Market Provider Performance, Sales, Clinical Operations, Stars & Risk Adjustment, Finance , Cross-Segment Contracting, Provider Relations, and Network ... Development & Solutions). Reporting to the Network Operations Senior Manager or Director, this individual ensures the effective performance management of the… more
- CVS Health (New Albany, OH)
- …care more personal, convenient and affordable. Aetna has an exciting opportunity for a Program Manager to join our Risk Adjustment Retrospective Program ... this role you will serve as a hybrid project manager and subject matter expert in Risk ...and reporting for the Risk Adjustment Retrospective Program for ACA, Medicare , MMP and DSNP… more
- University of Washington (Seattle, WA)
- …excitement, artistic pursuits and natural beauty. **POSITION PURPOSE** The Senior Clinical Risk Manager 's (Compliance Analyst (ES 10)) primary responsibility is ... and the University School of Medicine. The Senior Clinical Risk Manager works in close collaboration with...advice as component of the relevant UW quality improvement program . + Develop and deliver clinical risk … more
- Dana-Farber Cancer Institute (Brookline, MA)
- …staff, debriefs all individuals as indicated. Works collaboratively with the Patient Safety & Risk Program Manager to track progress of open action items ... The Risk Manager is a member of...surveys by the Department of Public Health, Centers for Medicare and Medicaid Services and The Joint Commission. +… more
- NorthWest Senior & Disability Services (Salem, OR)
- …+ Comply with OHA vaccination mandate for COVID-19. Work Environment/Physical Demands The Risk & Safety Manager typically works in an office environment and ... made to enable individuals with disabilities to perform the essential functions. Classification: Risk and Safety Manager Position Number: 104 Salary Range: M30… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Senior Risk Manager (Registered Nurse) Full-Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is the region's ... Forbes "Best Employer" seven times. Position Summary: The senior risk manager is responsible for the facility's...the facility, interfacing with defense legal counsel, administering the risk management program on a day-to-day basis,… more
- HCA Healthcare (San Antonio, TX)
- **Description** **Introduction** Do you have the career opportunities as a(an) Manager of Quality and Risk Management you want with your current employer? We ... student loan, certification support, dependent scholarships) + Colleague recognition program + Time Away From Work Program ...of colleagues. Do you want to work as a(an) Manager of Quality and Risk Management where… more
- The Cigna Group (Houston, TX)
- …Summary:** This role is responsible for supporting Cigna Medicare Advantage's Risk Adjustment & Stars program for assigned populations in an operational ... needs. The role will work under the direction of Risk Adjustment & Stars Provider Education Regional Manager...to assigned providers and internal matrix partners of Cigna Medicare 's programs specific to CMS Risk Adjustment… more
- Point32Health (MA)
- …here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the direction of the Risk Adjustment Supervisor/ Manager , performs accurate and timely review and ... a timely manner. Researches and resolves coding questions and risk adjustment regulatory issues. + Coding Program ...of healthcare operations. + Ability to read and understand Medicare Advantage and ACA Risk Adjustment protocols.… more