- Molina Healthcare (Warren, MI)
- …role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling ... complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data to evaluate healthcare...risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA… more
- Humana (Lansing, MI)
- …+ A strong understanding of clinical metrics and data (eg Quality measures, Risk Adjustment ratings, chronic condition management, PCP visit rates and ... interrelate across segments and/or enterprise-wide. **Regional VP of Health Services, Humana Medicare Advantage** As the Regional VP of Health Services, you will… more
- Humana (Lansing, MI)
- …processes, reporting, and visualizations for all Humana Healthy Horizons Medicaid Risk Adjustment , prospective programs, and interoperability. Takes initiative ... Managed Care + Experience in Medicaid + Experience in risk adjustment + Experience with data mining...use data to drive business outcomes and decisions + Advanced Degree in a quantitative discipline, such as Mathematics,… more