- UCLA Health (Los Angeles, CA)
- Description As the Compliance Manager , Risk Management & Oversight, you will play a key role in developing and managing processes that maintain essential ... elements of our compliance efforts within the Medicare Advantage program . In this role, you'll... processes, including policy management, training, regulatory submissions, and risk management. + Ensure adherence to CMS Medicare… more
- The Cigna Group (Nashville, TN)
- …lead complex analytics projects and initiatives for Cigna's Medicare Advantage Risk Adjustment business. The Manager will work collaboratively with business ... **Summary** The Risk Adjustment Reporting & Analytics Manager ...for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These… more
- Fallon Health (Worcester, MA)
- …strive to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE ( Program of All-Inclusive Care for the ... to end + Collect documentation feedback and submit to Manager for provider education efforts + Update risk... Manager for provider education efforts + Update risk adjustment software with all relevant chart review observations… more
- Centene Corporation (Cheyenne, WY)
- …Master's degree preferred. + 5+ years project implementation, product or program management experience. + Medicare Supplement Benefits (Dental, Vision, ... a fresh perspective on workplace flexibility. **Position Purpose:** Promote increased program efficiency, service levels, and value by leading the dental, vision… more
- The Cigna Group (St. Louis, MO)
- …3 days: Tuesday, Wednesday and other day of choosing)** **Summary:** The Stars and Risk Adjustment Operations Senior Advisor will report to the Stars and Risk ... with broader responsibility and more expansive business ownership. **Responsibilities:** _Stars and Risk Adjustment Chief of Staff_ + Act as a connection point… more
- The Cigna Group (Raleigh, NC)
- …revenue growth and management, and improve customer value and affordability for Cigna Medicare . The Clinical Programs Analytics Manager is an opportunity to lead ... complex analytics projects and produce insights related to Cigna's Medicare clinical programs. The Manager will work collaboratively with business analytics work… more
- The Cigna Group (Philadelphia, PA)
- Cigna Supplemental Benefits (CSB) has been growing rapidly with Medicare Supplement (MedSupp) annual revenues now exceeding $1.2b. The Medicare Supplement ... new business pricing strategy to drive profitable growth in the Medicare Supplement marketplace. Effectively communicate pricing strategy, positions, and changes to… more
- The Cigna Group (Maitland, FL)
- …travel between Tampa, Orlando, Jacksonville.** **Role Summary** The Provider Performance Manager is a key member of a cross-functional, collaborative organization ... Market Provider Performance, Sales, Health Services, Clinical, Stars & Risk Adjustment, Finance, Marketing, Cross-Segment Contracting, Provider Relations, and… more
- The Cigna Group (Denver, CO)
- …conduit to the providers and the individual that represents Cigna Medicare Advantage. The Provider Performance External Representative's responsibilities include: + ... 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 (Bloomfield, CT)
- …the Network Development and Strategy Team and reports to the Provider Contracting Senior Manager . This role is a key contributor to the development of the strategic ... value-based reimbursements with hospitals and other providers for Cigna's Medicare product lines (eg, Hospital systems, Ancillaries, and large physician… more
- The Cigna Group (Atlanta, GA)
- …includes Market Provider Performance, Sales, Clinical Operations, Stars & Risk Adjustment, Finance , Cross-Segment Contracting, Provider Relations, and Network ... Development & Solutions). Reporting to the Network Operations Senior Manager or Director, this individual ensures the effective performance management of the… more
- CVS Health (Hartford, CT)
- …office location, and some workdays from home. Aetna has an exciting opportunity for a Program Manager to join our Risk Adjustment Retrospective Program ... and reporting for the Risk Adjustment Retrospective Program for ACA, Medicare , MMP and DSNP...from home. Aetna has an exciting opportunity for a Program Manager to join our Risk… more
- The Cigna Group (Bloomfield, CT)
- The Bilingual Social Work Care Manager works with identified at risk members for care management intervention and coordination of the delivery of cost-effective ... required + Bilingual in Spanish preferred + Certified Case Manager Preferred + Three or more years' experience in...for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These… more
- CVS Health (New Albany, OH)
- …care more personal, convenient and affordable. Aetna has an exciting opportunity for a Program Manager to join our Risk Adjustment Retrospective Program ... this role you will serve as a hybrid project manager and subject matter expert in Risk ...and reporting for the Risk Adjustment Retrospective Program for ACA, Medicare , MMP and DSNP… more
- State of Colorado (CO)
- …for reporting compliance with Medicare 111 Act of 2007 (MMSEA) + Assist Risk Manager with information requested related to previous claims or processes over ... Deputy Risk Manager / Administrator IV DPA...backup to the director of the State Office of Risk Management, provides program management for lawsuits… more
- University of Washington (Seattle, WA)
- …intellectual excitement, artistic pursuits and natural beauty. **POSITION PURPOSE** The Risk Manager 's (Compliance Analyst (ES 10)) primary responsibility is ... assigned, within UW Medicine and the University Schools. The Risk Manager works in close collaboration with...advice as component of the relevant UW quality improvement program . + Develop and deliver clinical risk … more
- Molina Healthcare (Owensboro, KY)
- **JOB DESCRIPTION** **Job Summary** Responsible for retrospective risk adjustment programs involving department or cross-functional teams of subject matter experts, ... will not be limited to collaboration with finance to develop or modify program and vendor budgets; vendor procurement, deployment, and management; and Product Owners… more
- NorthWest Senior & Disability Services (Salem, OR)
- …+ Comply with OHA vaccination mandate for COVID-19. Work Environment/Physical Demands The Risk & Safety Manager typically works in an office environment and ... made to enable individuals with disabilities to perform the essential functions. Classification: Risk and Safety Manager Position Number: 104 Salary Range: M30… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Senior Risk Manager Full-Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is East Tennessee's top-performing ... Forbes as a Best Employer. Position Summary: The senior risk manager is responsible for the facility's...the facility, interfacing with defense legal counsel, administering the risk management program on a day-to-day basis,… more
- Sutter Health (Sacramento, CA)
- …program management in a healthcare or health plan setting. + Knowledge of risk adjustment program management. + Knowledge of health plan regulatory and ... **Organization:** Sutter Health Plan - Valley **Position Overview:** As a program management expert, the incumbent will develop, manage, and execute regulatory and… more