- Ankura (New York, NY)
- …investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment . The Senior Director will also support ... master's degree from an accredited college/university + 8+ years of experience in Medicare Risk Adjustment operations, internal audit, or compliance either… more
- Point32Health (Canton, MA)
- …with our corporate and business division goals. This position will report to the Director of Risk Adjustment Strategy, Operations and Quality Assurance. ... will oversee all provider engagement and reporting activities for risk adjustment programs and initiatives that impact Medicare , Medicaid, and Duals product… 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 ... hardwiring processes to drive excellence in efficiency of care, quality and accurate risk adjustment for all populations served, especially our patients covered… more
- CenterWell (Indianapolis, IN)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... heart of everything we do. As an **Associate Medical Director (AMD) at CenterWell Senior Primary Care,** you will...coaching initiatives are precise + Identify critical issues for high- risk patients during case reviews & other forums, and… more
- Point32Health (Canton, MA)
- …and will work in a matrix environment collaborating with functions including risk adjustment , population health, finance, operations, actuarial, and sales. **Job ... we are at Point32Health (https://www.point32health.org/) . **Job Summary** The Director of Contracting is responsible for contract strategy, development,… more
- CenterWell (Kansas City, KS)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... and help us put health first** The Associate Medical Director (AMD) is an instrumental clinical leader of our...coaching initiatives are precise. + Identify critical issues for high- risk patients during case reviews & other forums, and… more
- CenterWell (Columbia, SC)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... and help us put health first** The Associate Medical Director (AMD) is an instrumental clinical leader of our...coaching initiatives are precise + Identify critical issues for high- risk patients during case reviews & other forums, and… more
- CenterWell (Daytona Beach, FL)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... and help us put health first** The Associate Medical Director (AMD) is an instrumental clinical leader of our...and coaching initiatives are precise *Identify critical issues for high- risk patients during case reviews & other forums, and… more
- Martin's Point Health Care (Portland, ME)
- …to their management and strategic deployment. + Provides support to Health Plan risk adjustment activities as needed. + Is conversant with Health Plan ... as a "Great Place to Work" since 2015. Position Summary The Medical Director (MD) provides clinical leadership and direction to the utilization & care management… more
- Dignity Health (Bakersfield, CA)
- …and dual eligible populations, and benefit systems is preferred. - HEDIS/Stars and HCC/ Risk adjustment knowledge. \#LI-DH **Where You'll Work** The purpose of ... **Job Summary and Responsibilities** The Medical Director of Physician Engagement leads the development and execution of strategies to engage physicians and APPs,… more
- Centene Corporation (Harrisburg, PA)
- …related experience including quality improvement, HEDIS operations, and Risk Adjustment . Experience with quality rating systems, Medicare products, ... best practices towards achieving market and product quality and risk goals + Serve as subject matter expert in...business requirements and strategies for data capture to close risk and care gaps + Perform root cause analysis,… more
- CVS Health (Tallahassee, FL)
- …treatment protocols for DSNP/MMP and other complex health populations to optimize risk adjustment , clinical quality, and care management. * Actively participate ... oversight of DSNP/MMP complex populations (Dual-Eligible Special Needs Plan / Medicare -Medicaid Plan) * Develop and lead clinical strategy and objectives for… more
- Emanate Health (Covina, CA)
- …and billing staff to ensure accurate documentation, coding compliance, and optimal risk adjustment outcomes. The HCC Coding Specialist ensures the IPA's ... Risk Adjustment Factor (RAF) maintains or exceeds...medical record review, claims validation, and performance reporting for Medicare and Covered California lines of business. Job Requirements… more
- Hartford HealthCare (Farmington, CT)
- …observed to expected ratio (O:E), capture of appropriate severity of illness (SOI) and risk of mortality (ROM), risk adjustment and hierarchal condition ... capture (HCC) codes, risk adjustment , and other high quality documentation outcome measures. ....Evaluation and 1:1 discussions under the direction of CDI Manager/ Director . . Provides CDI subject matter expert guidance to… more
- St. Luke's University Health Network (Bethlehem, 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
- St. Luke's University Health Network (Sellersville, 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
- Point32Health (Canton, MA)
- …for key initiatives + Serve as the key liaison for Actuarial, Finance, Risk Adjustment , Corporate Data and Analytics, Medical Cost Management, and Pharmacy ... improvement recommendations based on analytic findings. Under the direction of the Director of Product Strategy, the Manager contributes to building presentations of… more
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