- VNS Health (Manhattan, NY)
- OverviewAs the Clinical Manager for Risk Adjustment , you will be at the forefront of our mission to optimize clinical coding practices and enhance the ... enhancements, changes, and new products. + Provides updates to Risk Adjustment Stakeholders on program clinical...Educates and collaborates with our providers in the continuous review and implementation of clinical documentation best… more
- VNS Health (Manhattan, NY)
- …evidencing deviations from coding protocols. Conducts chart review around Provider Risk Adjustment Activity and clinical documentation errors around HCC ... CMS Hierarchical Condition Categories (HCC). Participates in and supports the Medicare Risk Adjustment team-based environment to educate providers on coding… more
- SSM Health (MO)
- …that would support an accurateDRGassignment, SOI, and/or ROM.Assists in the mortality review and risk adjustment process utilizing third-party models. ... as well as the level of services rendered. The CDI Specialist assesses clinical documentation through extensive review of the medical record, interaction with… more
- Bristol Myers Squibb (Summit, NJ)
- …for the incumbent include ensuring accurate and timely maintenance and review of procedures and methods; providing compliance oversight; ensure accurate and ... timely review of manufacturing and laboratory investigations; and identifying any...interpret results and generate technical conclusions consistent with Quality risk management principles. + Must be able to note… more
- Fallon Health (Worcester, MA)
- …analyze and report on FCHP patient charts for the purpose of validating regulatory Risk Adjustment scores. The Chart Review Specialist will collect ... nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences,...for provider education efforts + Update risk adjustment software with all relevant chart review … more
- Fallon Health (Worcester, MA)
- …on Facebook, Twitter and LinkedIn. **Brief Summary of Purpose** : The primary role of the Risk Adjustment Analyst (RAA) will be to function as the Claims SME for ... the Risk Adjustment & Analytics Department. The RAAimplements... outcome improvement. The RAA will own the claims adjustment workflow associated with regulatory retrospective chart review… more
- Banner Health (Phoenix, AZ)
- …(PHSO), will serve as the clinical DYAD to the Executive Director of Risk Adjustment , co-leading a robust team that will support the plan and CIN ... **Primary City/State:** Phoenix, Arizona **Department Name:** Clinical Decision Making **Work Shift:** Day **Job Category:**...strategies and educational initiatives around the impact that accurate risk adjustment has on the performance of… more
- Baylor Scott & White Health (Columbus, OH)
- …Scott and White Health strategies and processes for lines of business subject to risk adjustment . **SALARY RANGE** The pay range for this position is $26.27/hr ... audits and creates provider scorecards to offer feedback on Risk Adjustment Methodology + Interprets health record...+ Knowledge of ICD-10-CM and CPT coding conventions, and clinical documentation + Knowledge of and compliance with standards… more
- MedKoder (Mandeville, LA)
- …hands-on production). Must have at least 1 year of specialized experience in Medicare Risk Adjustment disciplines- such as HCC, CCC HEDIS + Auditing experience a ... to providers. This includes the analysis and translation of medical and clinical diagnoses, procedures, injuries, or illnesses into designated numerical codes. This… more
- Fallon Health (Worcester, MA)
- …the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, ... claims data, through forecasting, statistical analyses, trending, regression analyses, risk assessment, and utilization assessment. Identifies key issues and trends… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …Quality Auditor & Educator provides education and training for the Risk Adjustment Coding team to ensure coding and clinical documentation accuracy and ... consistency. Collaborating with the Manager of Risk Adjustment Operations, this position will also...position will also develop, evaluate and administer a Quality Review Program by auditing medical records reviewed by the… more
- Commander, Navy Installations (Everett, WA)
- …abuse, and child abuse. Identify crisis situations (eg, suicide or homicide risk ) when conducting clinical assessments, and provide immediate crisis ... of Employment The incumbent must meet the qualification requirements for Tier II clinical providers described in SECNAVINST 1754.8, "Credentials Review and … more
- Bristol Myers Squibb (Princeton, NJ)
- …Risk Management and Central Monitoring Position is a critical member of the Clinical Oversight and Risk Management Leadership Team and accountable to develop ... holistic community of practice centered on quality by design, clinical trial risk management, efficient issue management,...the portfolio. - Lead and manage governance for ongoing review of portfolio risk to support successful… more
- The Cigna Group (Maitland, FL)
- …collaborative organization (which includes Market Provider Performance, Sales, Health Services, Clinical , Stars & Risk Adjustment , Finance, Marketing, ... provider partner relationships in order to drive optimal performance on Stars, risk adjustment , utilization management, and overall financial performance. +… more
- Bristol Myers Squibb (Summit, NJ)
- …root cause analysis and investigative measures. + Contribute to the writing, coordination, review , approval, and maintenance of the S12 Risk Management Standard ... place than here at BMS with our Cell Therapy team. The Senior Specialist Quality Risk Management CAR T is responsible for supporting the S-12 Cell Therapy Quality … more
- Bristol Myers Squibb (Princeton, NJ)
- …third-party risk management policies, procedures, and tools. + Monitor and review the performance and risk exposure of existing third-party relationships, ... personal lives. Read more: careers.bms.com/working-with-us . **Summary:** The Senior Director of Risk Diligence and Oversight will play a critical leadership role in… more
- St. Luke's Health System (Boise, ID)
- …management data; identifying risk issues; coordinating risk education and risk program development; coordinating review and investigation of events and ... to work. **Day in the Life** **:** Under limited supervision, reports to the Risk Management Administrator and supports the risk and claims management program… more
- The County of Los Angeles (Los Angeles, CA)
- MENTAL HEALTH CLINICAL SUPERVISOR Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/1371434) Apply MENTAL HEALTH CLINICAL SUPERVISOR Salary ... professional level and under the general direction of a licensed clinical program manager, supervises and coordinates multidisciplinary and ancillary support staff… more
- State of Maine, Bureau of Human Resources (Bangor, ME)
- …of all activities related to the review and mitigation of serious clinical risk and safety incidents. Manages initiatives that impact patient care and ... risk management assessment, incident analysis, and post mitigation review processes, procedures, and programs at Dorothea Dix Psychiatric Center. The… more
- Tufts Medicine (Burlington, MA)
- …4. Demonstrates a strong understanding of case mix index, MCC/CC capture, severity of illness/ risk of mortality, LOS, risk adjustment diagnoses. 5. Provides ... completeness, and accuracy of medical record documentation, obtains appropriate clinical documentation through extensive interaction with physicians, nursing staff,… more