- CVS Health (Hartford, CT)
- …the Aetna Better Health Medicaid Plans. Reporting to the Lead Director of Medicaid Risk Adjustment National Programs, this individual will work closely ... years of project management experience. Preferred Qualifications + 2+ years in Medicaid or Risk Adjustment health care industry experience. + Certified … more
- CVS Health (Hartford, CT)
- …has an exciting opportunity for a Senior Informatics Manager to join our dynamic Medicaid Risk Adjustment Analytics team! In this role you will provide ... Qualifications + Knowledge of government-regulated healthcare programs such as Medicaid or Medicare + Risk Adjustment...programs such as Medicaid or Medicare + Risk Adjustment experience/knowledge Education + Bachelor's Degree… more
- Henry Ford Health System (Troy, MI)
- The Manager , Risk Adjustment & Value Based Reimbursement has an important role in a high-profile group tasked with implementing system-wide improvements and ... Under minimal supervision from the Director, Risk Adjustment and Value Based Payment, the Manager ...departmental staff and multi-disciplinary teams. + Knowledge of Medicare, Medicaid , Blue Cross and other third party payers billing… more
- Point32Health (SC)
- …click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the direction of the Risk Adjustment Supervisor/ Manager , performs accurate and timely ... Medicaid HCCs through medical record reviews. The Risk Adjustment Coding Specialist II reviews provider...of action. Maintains productivity levels as defined by the Manager / Supervisor for a Coding Specialist II by… more
- Point32Health (SC)
- …click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the direction of the Risk Adjustment Supervisor/ Manager , performs accurate and timely ... Medicaid HCCs through medical record reviews. The Risk Adjustment Coding Specialist I reviews provider...Maintains productivity and accuracy levels as defined by the Manager / Supervisor for a Coding Specialist I by… more
- Universal Health Services (Reno, NV)
- …and enhancing the patient experience. Learn more at: https://prominence-health.com/ Job Summary: The Risk Adjustment Submissions Manager is a core member of ... to manage submissions and errors, applicable regulatory edits and business rules. The Risk Adjustment Submissions Manager maintains the throughput of… more
- CVS Health (Tallahassee, FL)
- …in Risk Adjustment payment models for Medicare Advantage, ACA and Medicaid . + Expertise in Risk Adjustment timelines and requirements + Prefer ... health care more personal, convenient and affordable. Position SummaryThe Purpose of the Manager , Business Consultation job is to monitor and manage day to day… more
- Molina Healthcare (Las Vegas, NV)
- **JOB DESCRIPTION** **Job Summary** Responsible for continuous quality improvements and risk adjustment accuracy for all government lines of business. Supports ... to engage with key providers. + Participates in state level quality and risk adjustment strategy meetings, develops a quality workplan, and ensures integration… more
- CVS Health (Woonsocket, RI)
- …actuarial team for forecasting and rate setting; serve as lead subject matter expert on Medicaid Risk Adjustment methodology and risk scoring; maintain ... is hiring for the following role in Woonsocket, RI: Manager , Informatics to formulate and apply mathematical and optimizing...risk evaluation and program implementation; track and analyze risk adjustment model versions and weights by… more
- MarketSource (Alpharetta, GA)
- 121666BRTitle:Compliance ManagerJob Description: Compliance Manager (Insurance) MarketSource Inc., an Allegis Group Company, develops and delivers innovative managed ... Summary Responsible for leading a team and driving regulatory compliance and risk mitigation efforts through the organization, by identifying risk areas… more
- Actalent (Los Angeles, CA)
- Largest national Medicaid Managed Care Organization is looking for a REMOTE RN Case Manager to join their growing team! Opportunity to make an impact with an ... experience with a national leader in managed care and Medicaid + Work in a fast-paced environment, handling 75...in integrated team care management rounds * Identify related risk management quality concerns and report these scenarios to… more
- Deloitte (Stamford, CT)
- …Medicaid waivers (ie, 1115, 1915 b/c, 1332) + 1+ years experience with risk adjustment mechanisms + 1+ years experience with Provider reimbursement streams ... Work you'll do As a Deloitte Consulting Health Actuary Manager in Deloitte's GPS Human Capital Actuarial and Insurance...Bachelor's Degree Required + 3 years' + experience with Medicaid managed care rate setting + 1+ years experience… more
- LA Care Health Plan (Los Angeles, CA)
- …Performance Management QI/QPM and Health Information Management (HIM) analytics support, Risk Adjustment , other plan operations business units, and network ... Clinical Quality Program Manager II (CAHPS) Job Category: Clinical Department: Quality...not limited to QI, Pharmacy, Care Management, Utilization Management, Risk Adjustment , Products, Customer Solution Center (CSC),… more
- LA Care Health Plan (Los Angeles, CA)
- Manager , Encounters Job Category: Administrative, HR, Business Professionals Department: Risk Adjustment Strategies & Initiatives Location: Los Angeles, CA, ... net required to achieve that purpose. Job Summary The Manager of Encounter Data is responsible for coaching staff...The position requires communicating with Centers for Medicare and Medicaid Services (CMS), The California Department of Health Care… more
- Access Dubuque (Dubuque, IA)
- Post Acute Case Manager **UnityPoint Health Finley Hospital** 1 Positions ID: 35168363 Posted On 05/16/2024 **Job Overview** **Overview** **Sign-On Bonus: $10,000 ... implementation, and evaluation of outcomes over the transition and adjustment period for patients discharged from the hospital to...Implement and facilitates process for post discharge calls to high- risk patients and rising risk as needed.… more
- Vatica Health (Albany, NY)
- …coding, healthcare billing, quality and Value Based Care measures and metrics. Risk Adjustment knowledge/experience is preferred. + Understanding of Medicare, ... The Manager of Clinical Operations leads and manages the Clinical...ACD, Medicaid , and health plan benefit structures. + Strong management experience… more
- Johns Hopkins University (Baltimore, MD)
- …data. + Provide research support on topics including cohort definition, risk adjustment scores, cost-sharing calculations, and provider-level data integration. ... populations, and technologies. The platform houses Centers for Medicare & Medicaid (CMS) health insurance claims data and is integrating next-generation data… more
- CareOregon (Portland, OR)
- …Medicare bid development, rate setting optimization, forecasting support, benchmarking, risk adjustment optimization, provider payment evaluation and review ... purposes of assessing our performance and the potential for improvement. + Monitor risk adjustment applied to capitation revenue and ensure population risk… more
- Trinity Health (Fresno, CA)
- …Trinity practices and policies. Partners with leadership to improve HCC and other Risk Adjustment capture with provider and coder education. Conducts ongoing ... **Employment Type:** Full time **Shift:** Day Shift **Description:** Reporting to the Manager Medical Group Revenue Cycle Site Operations, Fresno, this position is… 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 ... + Contribute towards the maintenance and enhancement of an effective Compliance Risk Assessment Program + Project manage regulator and other external reviews as… more