• VP Risk Adjustment Accuracy…

    Highmark Health (Blue Bell, PA)
    …At least five years' direct management experience Preferred: + 5 or more years' Medicare and/or Commercial risk adjustment experience + Previous involvement ... Development and Management: + Provide strategic leadership and management for the Risk Adjustment Accuracy Management Department. + Develop and oversee programs… more
    Highmark Health (07/30/25)
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  • Product Manager, Risk Adjustment…

    Datavant (Harrisburg, PA)
    …to realize our bold vision for healthcare. **Role Overview** As a Product Manager, Risk Adjustment Analytics Products, you will contribute to the strategy and ... execution of analytics capabilities that power Datavant's risk adjustment solutions. You'll drive the development of robust, scalable, and actionable analytics… more
    Datavant (06/06/25)
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  • Lead Director, Medicare Actuarial Analytics…

    CVS Health (Harrisburg, PA)
    …regulatory compliance. + Serve as a subject matter expert on CMS regulations, risk adjustment , and revenue optimization. + Collaborate with internal stakeholders ... CMS Part C/D operations. + 5+ years' experience working with CMS regulations, risk adjustment methodologies, and revenue management. + 5+ years' experience… more
    CVS Health (07/01/25)
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  • Vice President HEDIS Strategy

    AmeriHealth Caritas (Newtown Square, PA)
    …as the leader responsible for driving the Quality Performance Reporting & Analytics and Risk Adjustment for Medicaid Quality, Medicare Stars, and Exchange ... and collaboration across all levels. It combines expertise in risk adjustment and quality performance, with oversight...partnerships and optimize data abstraction and management + Direct advanced analytics functions to monitor risk scores… more
    AmeriHealth Caritas (07/30/25)
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  • Senior Client Coding Project Manager

    Datavant (Harrisburg, PA)
    …outpatient or inpatient setting. + Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment , CDI, Medicaid, Commercial RA, and HEDIS ... up to date with current coding policies for ICD-10, Medicare Advantage, HHS (ACA), and other markets. + Provide...clients understand the shifts and trends happening in the risk adjustment coding space. **What you will… more
    Datavant (06/28/25)
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  • Inpatient Registered Nurse (RN) or Social Worker…

    St. Luke's University Health Network (Coaldale, PA)
    …patient as healthy as possible in the outpatient setting, minimizing the risk of readmissions. + Issues applicable state/federal regulatory notices as applicable ... ie.) Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON),...(MOON), Bundle Payment Care Initiative (BPCI) notification. + Monitors risk assessment using available tools and implements discharge interventions… more
    St. Luke's University Health Network (07/17/25)
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