- Elevance Health (Chicago, IL)
- ** Director of Medicare Risk Adjustment Analytics and Reporting** **Location:** Alternate locations may be considered. This position will work a hybrid ... of our Elevance Health PulsePoint locations. The ** Director of Medicare Risk Adjustment Analytics and Reporting** is responsible for planning, directing… more
- Molina Healthcare (Kenosha, WI)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... **JOB DESCRIPTION** **Job Summary** The Medical Director for Specialty Medical Services & Market Performance..., and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews… more
- Ankura (Chicago, IL)
- …of regulatory and industry guidance related to medical necessity, utilization management, risk adjustment and clinical documentation requirements + Ability to ... and medical policy review and interpretation. + Conduct "mock" Centers for Medicare and Medicaid Services audits by reviewing cases for clinical decision making… more