- The Cigna Group (Bloomfield, CT)
- …needs of CMS Medicare Risk Adjustment processes and systems. The ** Medicare Risk Adjustment Analytics Advisor** would be a member of the ... if do not live near a Cigna Office]** We have an immediate need to strengthen our Risk Adjustment and Stars Enablement team. The Risk Adjustment and… more
- Elevance Health (St. Louis, MO)
- …actuarial studies. **How you will make an impact:** + Insources Medicare Advantage Risk Adjustment Analytics from vendors. + Analyzes and implements ... would provide an equivalent background. **Preferred skills, capabilities, and experiences:** Medicare Advantage and/or Medicaid Risk Adjustment experience… more
- Humana (Columbus, OH)
- …on underwriting margin. They will work collaboratively with peers across Medicare Risk Adjustment , Membership Growth Analytics , Medicare Finance, and ... with member cohort/segmentation, Medicare Membership Report (MMR), Medicare Risk Adjustment (MRA), or membership growth analytics **Scheduled Weekly… more
- Somatus (Mclean, VA)
- …and mental well-being + Community engagement opportunities + And more! The Sr. Director, Medicare Risk Adjustment (MRA) will lead the execution strategy and ... with Finance and Analytics team to establish risk adjustment analytics such as...experience required. + Proven experience with commercial and/ or Medicare Advantage risk adjustment functions.… 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...Health Care Administration, Public Health, Population Health, Finance, Business Analytics or related field and/or equivalent experience * Project… more
- VNS Health (Manhattan, NY)
- … adjustment values and formulas. + Supports response to Risk Adjustment Data Validation (RADV) audits by preparing analytics . + Builds reports and ... OverviewSupports initiatives that will impact the Risk Adjustment programs and operations. Collaborates with internal departments and external vendors on risk… more
- Molina Healthcare (Columbus, OH)
- **Job Description** **Job Summary** The AVP, Quality & Risk Adjustment is responsible for leading health plan execution for Risk Adjustment and Quality ... of strategy and activities with Enterprise, acting as the Risk Adjustment and Quality subject matter expert...Committee. + Collaborates with the MHI RQES teams for Risk and Quality Interventions supporting analytics and… more
- CVS Health (Blue Bell, PA)
- …has an exciting opportunity for a Program Manager to join our Risk Adjustment Retrospective Program for ACA, Medicare , MMP and DSNP lines of business! In ... provider/vendor/network outreach, production management, and reporting for the Risk Adjustment Retrospective Program for ACA, Medicare , MMP and DSNP lines… more
- The Cigna Group (Houston, TX)
- …care capabilities for Accountable Care. This role will be responsible for executing analytics around ACO/ Risk Bearing Entity programs to help measure and ... **Summary** The Business Analytics Lead will be an individual contributor responsible...trends, variances, and key issues and provide recommendations for adjustment + Prepare and improve financial analysis and forecasting… more
- Providence (WA)
- …for our Medicare Advantage plans + Have a deep understanding of Medicare Advantage regulations, risk adjustment methodologies, and a strong analytical ... **Providence Health Plan is calling a Senior Actuarial Analyst, Medicare Bid who will:** + Be responsible for developing...the pricing process + Staying informed of changes in risk adjustment methodologies and assess their implications… more
- The Cigna Group (Franklin, TN)
- …and Customer strategy, performing research and analysis within the Clinical, STARS, and Risk Adjustment Analytics team. Reporting to the Senior Manager ... recommendations based on relevant findings. The Clinical, STARS, and Risk Adjustment Analytics team seeks...clinical programs, customer value, growth, and retention for Cigna Medicare . This role will help us accomplish this through… more
- The Cigna Group (Atlanta, GA)
- …(which includes Market Provider Performance, Sales, Clinical Operations, Stars & Risk Adjustment , Finance , Cross-Segment Contracting, Provider Relations, and ... and financial and/or operational issues with providers. + Leading Stars & Risk Adjustment outcomes through local Provider Performance initiatives. Developing and… more
- LA Care Health Plan (Los Angeles, CA)
- …Informatics Experience Required: At least 6 years of experience in HEDIS, quality improvement, risk adjustment analytics , research, or related work within a ... Manager, Clinical Quality Analytics Job Category: Clinical Department: Quality Improvement Location:...of LA Care's line of business (LOB) which includes Medicare Stars, Exchange Quality Rating Systems and MediCal's Managed… more
- Amazon (San Francisco, CA)
- …drive growth * Play integral role in the creation and evolution of real-time risk adjustment factor prediction models in coordination with data engineering * ... business impact * Develop metrics for operational and claims completeness processes impacting Medicare risk * Work with Senior Health clinical leadership to… more
- The Cigna Group (Nashville, TN)
- …role will work with a series of stakeholders on setting our risk adjustment strategy. Reporting to the Medicare Advantage Revenue Finance lead, this position ... Medicare finance and operation teams to ensure appropriate risk adjustment goals are developed, set, and...progress, priorities, and key risks and opportunities. + Supports analytics partners in evaluating risk adjustment… more
- CVS Health (Blue Bell, PA)
- …Medicare Advantage, MSSP, ACO REACH).** **What will you do?** + Evaluate the impact of Medicare quality and risk adjustment program has on our MA risk ... opportunities, HCC gaps, and benchmarking analysis. + Develop analytics strategies to drive performance for our partners and...Medicare claims dataset -Ability to conduct actuarial and risk adjustment (CMS-HCC) analysis -Excellent oral &… more
- Mount Sinai Health System (New York, NY)
- …for driving key population health goals including access, quality, utilization and accurate risk adjustment with a group of practices and (2) close partnership ... team includes 400+ employees with clinical, contracting, finance, IT, analytics , operations, and product development expertise. MSHP is a...with the CDQI Director to drive accurate risk adjustment throughout the system. This Medical… more
- Healthfirst (NY)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRGs), ... to internal leadership and external stakeholders. + Support contract analytics and fee schedule modeling to aid in contract...New York related to Medicaid and CMS related to Medicare . + Bachelor's degree or higher from an accredited… more
- Genesis Healthcare (Kennett Square, PA)
- …topics driving outcomes including, but not limited to: financial performance, risk adjustment , utilization management, quality performance, clinical performance, ... ACO contracted primary care groups to optimize their success in LTC ACO's Medicare Shared Saving Program. The Partner Engagement Manager's top priorities are to… more
- CVS Health (Hartford, CT)
- …standard methods for measuring health care utilization, spending, quality, and outcomes; risk adjustment ; provider profiling; and related analytical tasks. + ... in one or more of the following areas: + Medicare Advantage, ACO, MSSP, ACO REACH + Healthcare Economics...Economics + Pricing + Reserving + Forecasting + Data Analytics + Excellent quantitative analysis abilities, grounded in epidemiology,… more