- 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
- 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
- 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
- Healthfirst (NY)
- … and Medicaid Services (CMS) practices, policies, and regulations. Expert knowledge of Medicare Risk Adjustment Payment Methodology, HCC, CRG and other ... leadership to analysts and staff in support of all processes related to risk adjustment for Medicaid, Medicare & QHP products. + Direct the communication… 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
- 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
- State of Colorado (Denver, CO)
- Clinical Therapist V / Director of Therapeutic Activities - Denver Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4817688) Apply Clinical ... Therapist V / Director of Therapeutic Activities - Denver Salary $2,825.54 - $3,956.31 Biweekly Location Denver, CO Job Type Full Time Job Number IIC-00531… more
- Bristol Myers Squibb (Washington, DC)
- …we pioneer. Join us and make a difference." " **Position Summary** " The Director , Policy and Reimbursement, Drug Pricing Policy, will serve as a deep technical ... and drug pricing across the BMS Enterprise . The Director will lead on shap ing drug pricing public...focus on IRA and drug pricing but including other Medicare /Medicaid programs and key priority policies."" + Assist in… 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
- Molina Healthcare (Columbus, OH)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in Utilization/Quality Program… more
- AdventHealth (La Grange, 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
- 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
- Commonwealth Care Alliance (Boston, MA)
- …+ Maintain current industry knowledge of highly impactful external audits such as Risk Adjustment Data Validation Audit, CMS Program Audit protocols, common ... Risk Assessment. + Make recommendations towards enhancements to the Continuous Compliance Risk Assessment process. + Alert Director of Internal Audit of… 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
- Whidbey General Hospital (Coupeville, WA)
- …in-hospital stay to discharge: When the patient and or family has specific adjustment or psych/social needs, the social worker is integrated into the care plan ... up may be indicated for patients who have been identified as high risk for re-hospitalization or non-compliance with recommended follow up care. + Facilitates… more
- St. Luke's University Health Network (Allentown, PA)
- …to: RN care managers, assistants, coordinators, utilization management staff, and director . + Facilitates communication among all treatment team members. + Manages ... patient as healthy as possible in the outpatient setting, minimizing the risk of readmissions. + Issues applicable state/federal regulatory notices as applicable… more
- AdventHealth (Hinsdale, IL)
- …under the general supervision of the Care Management Supervisor or Manager or Director of Nursing and is responsible for patient evaluations of post-hospital needs; ... social determinants of health into transitions of care planning and applies risk mitigation interventions to meet the individual needs of each patient **.**… more
- AdventHealth (Orlando, FL)
- …under the general supervision of the Care Managment Supervisor or Manager or Director of Nursing and is responsible for patient evaluations of post-hospital needs; ... social determinants of health into transitions of care planning and applies risk mitigation interventions to meet the individual needs of each patient Identifies… more
- AdventHealth (Daytona Beach, FL)
- …under the general supervision of the Care Managment Supervisor or Manager or Director of Nursing and is responsible for patient evaluations of post-hospital needs; ... Incorporates social determinants of health into transitions of care planning and applies risk mitigation interventions to meet the individual needs of each patient +… more