- Humana (Columbus, OH)
- …understanding of how organization capabilities interrelate across the function or segment. The Risk Adjustment Director of Compliance ensures compliance with ... understanding of how organizational capabilities interrelate across the function or segment. The Risk Adjustment Director of Compliance will be a key… more
- Marshfield Clinic (Marshfield, WI)
- …come together to support the most exciting missions in the world!** **Job Title:** Director of Actuarial and Risk Adjustment Services **Cost Center:** ... (United States of America) **Job Description:** **JOB SUMMARY** The Director of Actuarial & Risk Adjustment...excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment.… more
- BlueCross BlueShield of North Carolina (NC)
- …Arrangements (ACO/CIO) and Medicare Quality Initiatives (Stars and Risk Adjustment ). + Excellent presentation, communication and relationship building ... and Blue Shield of North Carolina (Blue Cross NC) is seeking a Medical Director , Medicare Strategy to join our Health Care division. In this dynamic role, you… more
- CareOregon (Portland, OR)
- …Exemption Status Exempt Management Level Manager Direct Reports Coding Auditors Manager Title Director , Risk Adjustment Pay and Benefits Estimated hiring ... Job Title Risk Adjustment Coding Manager Requisition #...adjustment coding and provider education programs for the Medicare Advantage and Medicaid product lines. This function is… more
- Point32Health (Canton, MA)
- …individual will be responsible for supporting critical data submission functions for the Risk Adjustment Department (RAD), including submissions to CMS and state ... timely resolution of production issues pertaining to state government and risk adjustment data submissions, including issue investigation, business requirements,… more
- Mount Sinai Health System (New York, NY)
- …adjustment with a group of practices and (2) close partnership with the CDQI Director to drive accurate risk adjustment throughout the system. This ... the status quo **Role Summary:** MSHP seeks a Medical Director (MD), Physician Engagement and CDQI, who will (1)...drive excellence in efficiency of care, quality and accurate risk adjustment for all populations served, especially… more
- WelbeHealth (Los Angeles, CA)
- …Python, R), Excel, and financial modeling tools + Deep understanding of CMS risk adjustment , Medicaid rate-setting, and Medicare Advantage/Part D payment ... and financial analysis. This role will focus on overseeing capitation rates, risk adjustment methodologies, claims forecasting, and Incurred But Not Reported… more
- CenterWell (Columbus, OH)
- …+ Ability to travel up to 20% **Preferred Qualifications** + Proven experience with Medicare Advantage risk adjustment functions. + Proven track record of ... entities within the Primary Care Organization. **Strategy:** + In partnership with AVP, Risk Adjustment and AVP, MRA Strategy, responsible for driving ongoing… more
- CVS Health (Aurora, CO)
- …+ Utilization Management + Network Management + Health Plan Management + Documentation/ Risk Adjustment + Clinical Compliance & Policy Development + This ... each and every day. **Company:** Oak Street Health **Title:** Senior Medical Director **Location:** Various Oak Street Health is a rapidly growing, innovative… more
- Molina Healthcare (Columbus, OH)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare ,… more
- Bristol Myers Squibb (Washington, DC)
- …every treatment we pioneer. Join us and make a difference. **Position Summary** The Director , 340B Policy Strategy, will serve as a deep technical expert in the ... plan for 340B across the BMS Enterprise . The Director will lead 340B strategies that shape public policy...with an acute focus on 340B but including other Medicare / Medicaid programs and key priority policies. +… more
- CVS Health (Chicago, IL)
- …health, transitions-in-care, pharmacy and medication adherence, HEDIS / Stars, accurate risk adjustment , preferred partner relationships, and remote monitoring. ... all with heart, each and every day. **Company:** **Oak Street Health** **Title:** Director , Population Health - Corporate Oak Street Health is a rapidly growing,… more
- Elevance Health (Nashville, TN)
- …and engages appropriate resources for solution. + Collaborates with Care Consulting, Pharmacy, and Risk Adjustment teams to drive Cost of care and HEDIS Star ... **Provider Collaboration Director -Tennessee** **Location:** This position will work a hybrid...to understand and implement complex value-based, partial, and full risk contracts. + Experience in Medicare and… more
- CVS Health (Des Moines, IA)
- …to, transitions-in-care, pharmacy and medication adherence, HEDIS / Stars, accurate risk adjustment , preferred partner relationships, and patient engagement ... heart, each and every day. **Company:** Oak Street Health **Title:** Population Health Director , Field **Company Description** The mission of Oak Street Health is to… more
- AdventHealth (Hinsdale, 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 (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
- CareOregon (Portland, OR)
- …# 24856 Exemption Status Exempt Management Level n/a Direct Reports n/a Manager Title Director Risk Adjustment Department Finance Pay and Benefits Estimated ... coder certification through AHIMA or AAPC + For Finance Department only: Current Certified Risk Adjustment Coder (CRC) or completion within one year of hire… more
- CenterLight Health System (NY)
- …on current performance. + Serves as a subject matter expert on Risk Adjustment Data Validation (RADV) audits from Medicare . + Perform random audits of coding ... Center Light Healthcare System. + Works with Site Medical Director /Attending Physician and Nursing in QA review of their...Manager (CPPM) 4. Certified Professional Biller (CPB) 5. Certified Risk Adjustment Coder (CRC). Experience: + Three… more
- VNS Health (Manhattan, NY)
- …reimbursement related issues; makes coding and documentation recommendations for adherence to risk adjustment models. + Reviews medical documentation to ensure ... documentation is accurate, precise, and adherent to CMS guidelines pertinent to Risk Adjustment Hierarchical Condition Category (HCC) methodology. + Assigns… more
- Molina Healthcare (Columbus, OH)
- …quality and risk adjustment VPs, Regional Directors of Quality/ Risk , Director of Value Based Programs, medical economics/actuaries and local health ... revenue management, strategy, and compliance + Knowledge of value based programs, risk adjustment models, quality metrics such as HEDIS and STARS, knowledge… more