- Humana (Harrisburg, PA)
- …is responsible for the overall success of Provider outcomes/results, Stars , and Risk Adjustment strategy and performance within a designated region as ... and their respective functions with a focus on Provider Engagement, outcomes/results, Quality/ Stars , and Medicare Risk Adjustment . Represents the health… more
- The Cigna Group (Houston, TX)
- …area.** **Job Summary:** This role is responsible for supporting Cigna Medicare Advantage's Risk Adjustment & Stars program for assigned populations in ... needs. The role will work under the direction of Risk Adjustment & Stars Provider...Understands, develops, tracks, monitors, and reports on key program performance metrics supporting complete and accurate documentation. + Review… more
- UCLA Health (Los Angeles, CA)
- Description As the Medicare Advantage Risk Adjustment Performance Improvement Consultant, you will be responsible for: + Serving as a Subject Matter Expert ... (SME) for risk adjustment with contracted IPAs + Collaborating...Knowledge of HIPAA regulations * Knowledge of Medicare Advantage, STARS /HEDIS program, and NCQA technical specifications, a plus *… more
- The Cigna Group (Atlanta, GA)
- …organization (which includes Market Provider Performance , Sales, Clinical Operations, Stars & Risk Adjustment , Finance , Cross-Segment Contracting, ... and financial and/or operational issues with providers. + Leading Stars & Risk Adjustment outcomes...+ Leading Stars & Risk Adjustment outcomes through local Provider Performance initiatives.… more
- Highmark Health (Columbus, OH)
- …performance under value based reimbursement contracts, STARs performance , HEDIS performance , Risk Adjustment documentation and any other risk ... and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control… more
- The Cigna Group (Houston, TX)
- …(which includes Market Provider Performance , Sales, Health Services, Clinical, Stars & Risk Adjustment , Finance, Marketing, Cross-Segment Contracting, ... partner relationships in order to drive optimal performance on Stars , risk adjustment , utilization management, and overall financial performance .… more
- The Cigna Group (Seattle, WA)
- …+ 3+ years of direct provider-facing experience or direct health plan experience with STARS , HEDIS, Risk Adjustment and medical expense reduction, specific ... on 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 (Sunrise, FL)
- …+ 3+ years of direct provider-facing experience or direct health plan experience with STARS , HEDIS, Risk Adjustment and medical expense reduction, specific ... on topics including, but not limited to: preventative and quality outcome metrics, risk adjustment , medical cost management, etc. + Schedules, prepares for and… more
- Molina Healthcare (Albuquerque, NM)
- …related to activities in all government lines of business impacted by regulatory risk adjustment payment model. Accountable for designing and implementing a ... overall achievement of improved accuracy, compliancy, and completeness in risk adjustment revenue for all government lines...adjustment models, quality metrics such as HEDIS and STARS , knowledge of coding + Knowledge of medical economics… more
- The Cigna Group (Bloomfield, CT)
- …This position is responsible for leading and evolving the optimization of the Stars and Risk Adjustment (SRA) Enablement Interoperability strategic ... roadmap and initiatives in collaboration with matrix partners with a focus on Medicare Advantage Stars and Risk Adjustment lenses. + Develop and execute of… more
- Health First (Rockledge, FL)
- …ratings. * Ensure financial impact to organization as well as data submitted for Risk adjustment and HEDIS measures is complete, accurate and thorough to ... risk of regulatory agency audits. * Gain a thorough understanding of the Risk Adjustment payment methodology, submission requirements and their impact to the… more
- The Cigna Group (Nashville, TN)
- …(at least one of the below):** Certified Professional Coder (CPC) Certified Risk Adjustment Coder (CRC) Certified Coding Specialist for Providers (CCS-P) ... inpatient / outpatient or medical office coding experience, preferably two years risk adjustment coding experience. + Extensive knowledge and adherence to… more
- LA Care Health Plan (Los Angeles, CA)
- …Experience Required: At least 6 years of experience in HEDIS, quality improvement, risk adjustment analytics, research, or related work within a healthcare ... LA Care's line of business (LOB) which includes Medicare Stars , Exchange Quality Rating Systems and MediCal's Managed Care...as RAF scores, open care gaps and quality improvement performance to enable a targeted and tailored outreach for… more
- LA Care Health Plan (Los Angeles, CA)
- …Performance Management QI/QPM and Health Information Management (HIM) analytics support, Risk Adjustment , other plan operations business units, and network ... including but not limited to QI, Pharmacy, Care Management, Utilization Management, Risk Adjustment , Products, Customer Solution Center (CSC), reporting and… more
- Humana (Louisville, KY)
- …needed in addition to an eagerness to learn. + Works with other associates in Stars Analytics and Medicare Risk Adjustment + Distills complex financial and ... in Medicare and Medicaid regulations and payment models, monitors and reports on risk adjustment data submissions, and supports HQRI operations. This role will… more
- Molina Healthcare (NM)
- …Coordinates accountabilities between segment and markets to drive performance in network, risk adjustment , and stars ; single point of contact for ... between segment, health plans, and shared services to drive compliance and performance objectives as well as provide oversight, including service level agreements. +… more
- Parsons Corporation (Boise, ID)
- …procedures** **Ensuring readiness for and coordinating maintenance, repair, and adjustment of equipment and systems during startup testing, and commissioning** ... functional testing of the facility** **Coordinate and oversee Emissions and Performance testing of the facility** **Promptly reports Safety, Health, or Environmental… more
- Sharp HealthCare (San Diego, CA)
- …as needed.Supports completion of quality initiatives per internal and external guidelines: AMP, HEDIS/ STARS , CIN, risk adjustment , etc. + Communication and ... Clinical Quality team by the effective coordination and maintenance of performance improvement initiatives related to the clinical quality metrics. This position… more
- Sharp HealthCare (San Diego, CA)
- …needed. Supports completion of quality initiatives per internal and external guidelines: AMP, HEDIS/ STARS , CIN, risk adjustment , etc. + Communication and ... Clinical Quality team by the effective coordination and maintenance of performance improvement initiatives related to the clinical quality metrics. This position… more
- Molina Healthcare (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 ... Coordination Organizations are met * Develops and sustains a high- performance team, dedicated to best-in-class solutions, responsible for attracting, developing,… more